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Biomedical subjects

W D Edwards

Publications and source records attributed to W D Edwards.

At least 325 records · Page 18Linked to original sources
PubMed1977

Effects of androgens and/or prolactin on ventral prostate transplants.

When testosterone (T) or dihydrotestosterone (DHT) pellets (15 mg) were implanted into host male rats of different ages bearing ventral prostate transplants obtained from donors of varying ages, the in situ tissues generally contained more DNA than did the transplanted tissues. Hosts implanted with T, and in particular in the transplanted ventral prostate tissues, contained higher levels of DNA than in those host implanted with DHT. Neither the donor or host age (6-12 weeks) nor the duration of the transplant (6 or 12 weeks) seemed to have any demonstrable effect upon the levels of DNA in the transplant itself or in the in situ prostate. The in vitro incubations of slices of either the transplant or the host's prostate with testosterone-3H revealed that both tissues could effectively synthesize dihydrotestosterone-3H and androstanediol-3H. However, the transplanted tissues was less capable of such steroid metabolism, and overall was 1/3-1/2 as effective as the host prostate tissues in vitro. The acinar epithelial cell heights and the cellular secretory activities in the transplants were often similar to those examined from the host's in situ ventral prostate. Prolactin (50 IU/kg daily X 5) did not affect DNA levels in either the transplants or the in situ prostate, but this hormone did accelerate the formation of DHT-3H in the situ prostate in vitro.

Animals↗
PubMed1977

Conjoined thoracopagus twins.

A case of vaginally delivered stillborn female thoracopagus conjoined twins is presented. Each twin had a cleft lip and cleft palate. They shared a common pericardial sac and a common abdominal cavity. The liver was conjoined, and the small bowel was common to both twins. One twin was asplenic. Although the twins were monozygotic, their viscera were neither identical nor mirror-image to each other, and the visceral anomalies were unique to each twin. The hearts were fused, and communications existed between the circulations at the atrial and ventricular levels. One twin had single atrium, solitary (right) ventricle, malposed great arteries, pulmonary valvular atresia and infundibular stenosis, right aortic arch with aberrant left subclavian artery and with left ductus arteriosus, and atresia of the common pulmonary vein. The other twin had two atrial septal defects of the fossa ovalis and sinus venosus types, partial anomalous pulmonary venous connection, persistent left superior vena cava to coronary sinus, solitary (left) ventricle, malposed great arteries, and left aortic arch with aberrant right subclavian artery and with left ductus arteriosus. There was atrial and ventricular fusion. On hypothetical grounds, and in a comparable anatomic situation, salvage of one twin might be possible by surgical means, while the other twin was sacrificed.

Abnormalities, Multiple↗
PubMed1977

Clinical primary pulmonary hypertension: three pathologic types.

Clinically, there is a group of patients with elevated pulmonary arterial pressure in whom the underlying cause is not apparent. The pulmonary arterial wedge pressure is not elevated. For such cases, the designation of primary pulmonary hypertension may be made clinically. From the clinical categorization of primary pulmonary hypertension, three distinct pathologic entities emerge, namely 1) plexogenic pulmonary arteriopathy, 2) recurrent pulmonary thromboembolism, and 3) pulmonary veno-occlusive disease. The plexogenic type is characterized initially by pulmonary arterial vasoconstriction with medial hypertrophy. Secondary proliferative intimal lesions, including the plexiform lesion, develop. Recurrent pulmonary thromboembolism is characterized by the presence of arterial thrombi of varying ages involving the microscopic-sized pulmonary arteries. Thrombi may be embolic in nature or may develop in situ. Pulmonary veno-occlusive disease is characterized by obstructive lesions of pulmonary veins and venules. The clinical presentation of the three pathologic types may be so similar that definitive diagnosis depends upon histologic examination of the lung from tissue obtained either by biopsy or at necropsy.

Arterioles↗
PubMed1976

Effects of prolactin and dihydrotestosterone upon the rat prostate gland.

The simultaneous subcutaneous injections of dihydrotestosterone (0.5 mg/kg) and/or ovine prolactin (5 or 50 IU/kg) to mature castrate rats for periods of 5-10 days led to an augmentation of prostate gland levels of RNA, DNA and protein. Of the various lobes of the prostate gland, the dorsal portion seemed to be particularly sensitive to the effects of the combined hormone treatment. In general, the highest dose of prolactin (50 IU/kg) and the longer duration of administration (10 days) produced the most consistent augmentation responses between dihydrotestosterone and prolactin as compared to those rats receiving only androgen. These findings reveal that certain lobes of the prostate are more responsive to hormonal interactions, but do not clarify the mechanisms involved in causing such enhancements of prostate cell growth and proliferation.

Animals↗
PubMed1976

Organ culture of rodent prostate. Effects of polyamines and testosterone.

Prostate organs were maintained in culture for 14 days on a plasma clot to which insulin, testosterone, spermine, and spermidine were added. Explants cultured in the control medium (embryo extract and chicken plasma) showed regressive changes and there was complete necrosis by the 5th day. When cultured in the presence of testosterone plus the control medium the explants continued to maintain their epithelial height and stromal characteristics after 5 days. By the 7th day regressive changes similar to those seen for explants cultured in the absence of testosterone were observed. With spermine and spermidine in the medium along with insulin and testosterone, the stromal and epithelial integrity of the explants was kept intact for 14 days. When either testosterone or spermine was omitted from this list of additives, survival and maintenance of normal morphology were greatly impaired. Omission of spermidine did not affect results if the other chemicals were added. No attempts were made to maintain cultures beyond 14 days.

Animals↗
PubMed1975

Metastatic atypical fibroxanthoma of skin.

A case is presented of postirradiation atypical fibroxanthoma of the skin, metastatic to cervical lymph node, in a young female. Although such skin tumors characteristically have a malignant microscopic appearance, and although they occasionally recur following surgical excision, they have previously been noted for their consistently benign clinical behavior. This is thought to be the second recorded instance of metastasis from an atypical fibroxanthoma of skin.

Acne Vulgaris↗
PubMed1975

Transplantations of isologous prostatic tissue in cleared mammary fat pads of BALB/c mice and F344 rats.

The cleared inguinal (mammary) fat-pad of male and female BALB/c mice and F344 rats was found to be a suitable site for maintaining prostate transplants. Uncastrated syngeneic hosts were stimulated by testosterone propionate pellets implanted under their dorsal skin. Transplants survived in testosterone-stimulated male and female hosts for as long as 21 months, at which time the experiment was terminated. However, transplants did not survive in unstimulated female hosts. Histological examination of transplants in stimulated animals showed that the epithelial height was maintained and there was increased secretory activity. Attempts to maintain prostate transplants in spleen, kidney capsule, and in scapulat fat-pad for long periods were unsuccessful. Transplants at these sites survived for less than 1 year, the epithelium was low and irregular, and palpation of the transplants was difficult. The prolonged viability of prostate transplants in cleared inguinal mammary fat-pads should facilitate the study of the effects of carcinogens and/or hormones on the prostate.

Adipose Tissue↗
PubMedDate not supplied

Intrauterine closure of membranous ventricular septal defects: mechanism of closure in two autopsy specimens.

Anatomic evidence of intrauterine closure of ventricular septal defects (VSDs) has been reported rarely. Between 1985 and 1990, 112 autopsies were performed at the Mayo Clinic on third trimester stillborns and infants who died during the first week of life. There were 21 (19%) cases of congenital heart disease. VSD was found in 12 (11%) cases: in eight (7%) as a part of a more complex heart defect and in four (4%) as an isolated lesion. Two cases with membranous VSDs with tricuspid valve tissue partially occluding the ventricular septal defect were found. A 2280-g female infant (case 1) with trisomy 18 died at 4 days of age. Autopsy revealed bilateral superior venae cavae, a large atrial septal defect, cor triatriatum, an atypical tricuspid valve with large septal leaflet partially obstructing a large membranous VSD, a hypoplastic right ventricle, and severe pulmonic stenosis. A 2610-g female infant (case 2), born with congenital heart block died at 4 days of age. Autopsy revealed cor triatriatum dexter obstructing the tricuspid orifice, a large membranous VSD partially obstructed by the septal leaflet of the tricuspid valve, four small muscular VSDs, and pulmonic stenosis. These cases suggest that closure of membranous VSDs may begin in utero and the mechanism of closure is similar to that reported postnatally.

Female↗
PubMedDate not supplied

Angiographic determination of ventricular morphology: correlation with pathology in 36 hearts with single functional ventricles.

Among 36 patients with univentricular atrioventricular connections, 27 had left ventricular and 9 right ventricular morphology. None had a common or indeterminate ventricle on autopsy review. Angiographic analysis correctly determined ventricular morphology in 34 (94%) of 36 patients. All 9 patients with right ventricular morphology of the dominant ventricular chamber were correctly identified angiographically. Altogether 25 of 27 patients (93%) with left ventricular morphology of the dominate ventricular chamber were correctly identified angiographically. Two patients with left ventricular morphology and severely dilated ventricles were incorrectly classified as having right ventricular morphology by angiographic assessment. For patients with a single functional ventricle, we conclude that angiographic assessment is an excellent method for determining ventricular morphology.

Adolescent↗
PubMedDate not supplied

Internal cardiac crux: two-dimensional echocardiography of normal and congenitally abnormal hearts.

The internal cardiac crux is an important anatomic landmark for the appreciation of both normal and congenitally altered anatomy. The four-chamber two-dimensional echocardiographic plane of section at the internal crux is the most feasible tomographic plane. The unique noninvasive access to the internal crux anatomy is frequently more sensitive and diagnostic than other imaging modalities, including angiography. This report describes the echocardiographic and anatomic landmarks of the normal crux and the more frequent congenital anomalies that alter these relationships.

Ebstein Anomaly↗
PubMedDate not supplied

Use of transesophageal echocardiography for improving detection of valvular vegetations in subacute bacterial endocarditis.

Subacute bacterial endocarditis is associated with significant morbidity and mortality. Valvular destruction, congestive heart failure, embolic phenomena, failure of medical therapy, and death are all more common in patients with echocardiographically discernible valvular lesions. Transthoracic echocardiography is often unsatisfactory for evaluation of vegetations in patients with chest wall deformities, lung disease, obesity, or prosthetic valves. The transesophageal approach affords uniformly high-quality images with excellent structural resolution. We present a case of suspected subacute bacterial endocarditis in a patient with equivocal diagnoses of vegetations on three separate transthoracic echocardiograms in whom transesophageal evaluation revealed obvious large vegetations that involved the aortic and mitral valves. Subsequent autopsy confirmed this diagnosis. The case illustrates the utility of a new imaging method for the detection of valvular vegetations. In view of the prognostic implications of detected vegetations, transesophageal echocardiography probably should be performed on all patients with suspected subacute bacterial endocarditis and equivocal results by transthoracic study.

Aged↗
PubMedDate not supplied

Right ventricular infarction associated with anteroseptal myocardial infarction: a clinicopathologic study of nine cases.

The association of right ventricular (RV) infarction with inferoseptal myocardial infarction is well established. However, a question remains about the occurrence of RV infarction in association with anteroseptal myocardial infarction. To determine the frequency and clinical correlates of this entity, we studied autopsied hearts from patients with isolated anteroseptal left ventricular (LV) infarcts. Among 3,249 autopsy specimens, 88 cases were identified. From each, sections were taken from the RV anterior, lateral, and inferior regions at basal, middle, and apical levels. All 1,584 slides were reviewed by blinded assessment. RV and LV infarcts were compared to confirm similarity in age. Patient records and cardiac investigations were reviewed for evidence of RV involvement. Of the 88 hearts with anteroseptal LV infarcts, 9 (10%) had coexistent RV infarction (6, old; 3, new). For these 9, the RV infarction involved 11% to 33% of the RV area, and the left anterior descending coronary artery was the infarct-related artery in each. All 3 patients who had an echocardiographic examination within 4 weeks of anteroseptal LV infarction had RV dysfunction. One patient, studied 15 years after infarction, had a normal right ventricle by echocardiography. In 3 patients with acute myocardial infarction, right heart catheterization during the acute phase revealed increased right-sided diastolic pressures out of proportion to left-sided diastolic pressures (right atrial pressure to pulmonary capillary wedge pressure, 60% to 95%). In conclusion, 10% of patients with an isolated anteroseptal LV infarct had evidence of RV free wall infarction. The RV infarction was associated with identifiable hemodynamic and echocardiographic features.

Adult↗
PubMedDate not supplied

Surgical pathology of the parietal pericardium: a study of 344 cases (1993-1999).

Among 344 cases with surgically resected parietal pericardium, ages ranged from 1 to 87 years (mean, 55), and 64% were male. Causes of pericardial disease included neoplastic (33%), idiopathic (30%), iatrogenic (23%), and others (14%). Pericardial constriction (Group 1) represented the largest group (143 cases, 76% male). Maximal pericardial thickness was 1-17 mm (mean, 4). Fibrotic thickening occurred in 96%. Chronic lymphoplasmacytic inflammation affected 73% (mild or moderate in 97%). Calcification was uncommon (gross in 28%, microscopic in 8%), and granulomas were rare (4%, none tubercular). Constriction was idiopathic in 49% and iatrogenic (postpericardiotomy or postirradiation) in 41%. Neoplasms and cysts (Group 2) represented the second largest group (96 cases). Among 43 cases with secondary pericardial involvement, carcinomas accounted for 53% and lymphomas 21%. Forty cases (Group 3) had pericardial effusions (75% chronic), which were idiopathic in 28% and postpericardiotomy in 23%. Thirty-three cases (Group 4) had acute or recurrent pericarditis clinically, which was idiopathic in 70%. Lastly, 32 cases (Group 5) had pericardial resection for conditions unrelated to primary pericardial disease. In conclusion, pericardial constriction tended to be nontubercular (100%), nongranulomatous (96%), idiopathic or iatrogenic (90%), and noncalcific (64%), and it could occur with normal pericardial thickness (4%). Because considerable overlap in the gross and microscopic features existed among cases with noncalcific pericardial constriction (Group 1), pericardial effusions (Group 3), and pericarditis (Group 4), clinical information was necessary to provide an accurate clinicopathologic interpretation.

Adolescent↗
PubMedDate not supplied

Acute aortic regurgitation due to spontaneous rupture of a fenestrated cusp: report in a 65-year-old man and review of seven additional cases.

A 65-year-old man with chronic hypertension developed dyspnea, a cough, and a new diastolic murmur. Two-dimensional echocardiography showed severe aortic regurgitation. No valvular vegetations were identified and blood cultures were negative. Surgical intervention was recommended, but the patient died of an acute intracranial hemorrhage two weeks later. At autopsy, the posterior aortic cusp was flail, due to rupture of the residual cord above two large fenestrations. There was no acute or healed endocarditis. To our knowledge, this is the eighth reported case of aortic valve incompetence due to spontaneous rupture of a fenestrated cusp. Patients ranged in age from 31-67 years (mean, 54), and 4 (50%) were older than 60 years. Seven (88%) of the 8 were men, and 4 (57%) of 7 had chronic hypertension. Analogously, in another four reported cases, aortic insufficiency developed following spontaneous rupture of the fenestrated raphe of an atypical congenitally bicuspid aortic valve. Noninfective and nontraumatic rupture of cord-like aortic valve structures may result in severe acute aortic regurgitation, particularly in men with chronic hypertension.

Acute Disease↗
PubMedDate not supplied

Pathology of acute and chronic coronary stenting in humans.

BACKGROUND: Despite the increasing use of stents, few reports have described human coronary artery morphology early and late after stenting. METHODS AND RESULTS: Histology was performed on 55 stents in 35 coronary vessels (32 native arteries and 3 vein grafts) from 32 patients. The mean duration of stent placement was 39+/-82 days. Fibrin, platelets, and neutrophils were associated with stent struts </=11 days after deployment. In stents implanted for </=3 days, only 3% of struts in contact with fibrous plaque had >20 associated inflammatory cells compared with 44% of struts embedded in a lipid core and 36% of struts in contact with damaged media (P<0.001). Neointimal growth determined late histological success, and increased neointimal growth correlated with increased stent size relative to the proximal reference lumen area. Neointimal thickness was greater for struts associated with medial damage than struts in contact with plaque (P<0.0001) or intact media (P<0.0001). When matched for time since treatment, neointimal cell density in stented arteries was similar to that in unstented arteries that had undergone balloon angioplasty and showed similar proteoglycan deposition. CONCLUSIONS: Morphology after coronary stenting demonstrates early thrombus formation and acute inflammation followed by neointimal growth. Medial injury and lipid core penetration by struts result in increased inflammation. Neointima increases as the ratio of stent area to reference lumen area increases. Deployment strategies that reduce medial damage and avoid stent oversizing may lower the frequency of in-stent restenosis.

Angioplasty, Balloon, Coronary↗