Biomedical subjects

William D Edwards

Publications and source records attributed to William D Edwards.

50 records · Page 3Linked to original sources

PubMed2002

Iatrogenic cardiac papillary fibroelastoma: a study of 12 cases (1990 to 2000).

Cardiac papillary fibroelastoma (PFE) is a rare, benign, slow-growing tumor of the endocardium. Whether it represents a reactive tumoral lesion or a true neoplasm remains a matter of debate. However, an anecdotal association of PFEs with previous cardiac surgery has been reported. The current study was undertaken to determine the frequency and nature of iatrogenic events associated with PFEs and to provide a comprehensive review of the topic. The study group comprised 12 cases seen between 1990 and 2000, with specimens from 7 women and 5 men. Six developed postoperatively and 6 developed after thoracic irradiation. The 9 Mayo cases represented 18% of all surgically excised PFEs during the study period. The mean age at operation was 54 years (range, 29 to 79 years). The mean interval between the iatrogenic event and excision of the tumor was 18 years (range, 9 to 31 years). In 58% of cases, the presence of multiple tumors was either confirmed pathologically (41.7%) or strongly suggested by echocardiography (16.6%). Among patients who had undergone previous cardiac surgery, PFEs were found in the chamber closest to the procedure. Similarly, in patients who had received radiation therapy, tumors developed in the left atrium, in the right ventricle and atrium, and on the tricuspid valve within the radiation field. In conclusion, iatrogenic PFEs may be relatively common among all such tumors, are frequently multiple, and often involve nonvalvular endocardial surfaces.

Adult↗

PubMed2002

Obstructive external iliac arteriopathy in avid bicyclists: new and variable histopathologic features in four women.

OBJECTIVE: Avid competition bicycling may be associated with the development of external iliac artery stenosis. European studies have documented endofibrosis that primarily has affected young men. Our objective was to review the histopathologic features of obstructed external iliac arteries resected from avid competition bicyclists at a single institution. METHOD: Medical records and microscopic slides were reviewed from all competitive bicyclists who had undergone resection and graft placement for segmental external iliac artery disease at Mayo Clinic (Rochester, Minn) between 1991 and 2001. RESULTS: Of seven patients (five female, two male) seen with external iliac obstructive disease, four underwent resection and graft placement and thus had specimens available for histopathologic review. Ages of these four patients, all of whom were women, ranged from 31-40 years (mean, 36 years). Claudication was the primary symptom in all four women. There were five iliac arteries involved in the four women, and pre-operative arteriography showed stenotic disease in these arteries, ranging from subtle stenosis to occlusion. Gross examination of the five resected arteries showed wall thickening and luminal narrowing, without aneurysm formation. Microscopically, luminal thrombus was observed in two arteries (one old and one recent). Intimal thickening affected four specimens (symmetric in three and asymmetric in one). Thickening was the result of smooth muscle hyperplasia, with only mild collagen or elastin deposition. Medial hypertrophy was present in three specimens (symmetric in two and asymmetric in one), one of which also contained focal calcification. Adventitial thickening was prominent in four (symmetric in two and asymmetric in two) and was due to smooth muscle hyperplasia. There was no intimal, medial, or adventitial inflammation. CONCLUSIONS: In contrast to previous reports, iliac arteriopathy among competition bicyclists may occur in women. The microscopic lesions responsible for stenosis are more varied than the "endofibrosis" that has been previously documented. In addition to the intimal fibrosis and luminal thrombosis noted by others, we describe medial and adventitial responses to repetitive trauma. Accordingly, we favor the term "external iliac arteriopathy" for this disease entity.

Adult↗

PubMed2002

Radiation arteritis following treatment for Wilms' tumor: an unusual case of weight loss.

Wilms' tumor is the most common pediatric primary renal cancer and is highly responsive to surgery and chemotherapy. The role of radiotherapy has evolved in the last three decades from the use of stepwise incremental doses in all patients to the current concept of added radiotherapy in advanced cases or in those with unfavorable pathology. To the authors' knowledge, this is the first case of a young woman with prior history of Wilms' tumor and significant weight loss due to radiation arteritis involving the abdominal vasculature. A 31-year-old woman presented with a history of weight loss and severe malnutrition. An angiogram revealed that the aorta was occluded below the renal artery. The celiac artery and the superior mesenteric artery were occluded at the origin, and large intercostal collaterals reconstituted the pelvic circulation. She was initially treated with total parenteral nutrition (TPN) and underwent an infrarenal aortic bypass surgery. Histopathology of the aorta revealed intimal fibrocalcific thickening and changes consistent with radiation-induced arteritis. Later, she was readmitted with progressive hepatic insufficiency. Despite intensive medical therapy, she died of multi-organ failure.

Adult↗

PubMed2002

Valvular heart disease in patients taking pergolide.

OBJECTIVE: To determine whether an association exists between pergolide and valvular heart disease. PATIENTS AND METHODS: Three patients with severe, unexplained tricuspid regurgitation were examined at our institution from September 2000 to April 2002. Echocardiography and histology of surgically explanted valves revealed abnormalities suggestive of carcinoid involvement, methysergide or ergotamine treatment, or use of fenfluramine and dexfenfluramine. Carcinoid valvular heart disease was excluded. None of the patients had prior treatment with these drugs. All 3 patients were taking pergolide. RESULTS: Of the 3 patients, 2 had predominantly right-sided congestive heart failure. In all 3 patients, echocardiography showed unusual valve morphology, with severe tricuspid valve regurgitation. Significant left-sided valve regurgitation was noted in 2 patients. Histologic analysis revealed surface fibroproliferative lesions with preserved underlying valve architecture. CONCLUSION: The echocardiographic and histopathologic features of these cases are strikingly similar to those associated with carcinoid-, ergot-, and fenfluramine-induced valve disease. An association between pergolide and valvular heart disease may therefore exist.

Aged↗

PubMed2002

Surgical pathology of carcinoid heart disease: a study of 139 valves from 75 patients spanning 20 years.

OBJECTIVE: To quantitate the pathologic features of carcinoid plaques in a relatively large number of surgical specimens from a single institution. PATIENTS AND METHODS: Medical records, operative reports, and surgical specimens were reviewed from all patients with carcinoid heart disease who underwent cardiac valvular surgery at Mayo Clinic, Rochester, Minn, between 1980 and 2000. RESULTS: The study group included 75 patients (45 men, 30 women) who ranged in age from 26 to 78 years (mean, 59 years). From these 75 patients, 139 valves had been excised surgically (73 tricuspid, 55 pulmonary, 6 mitral, 5 aortic). Pure regurgitation was the most common dysfunctional state of the tricuspid valve (80% [60/75]), mitral valve (97% [32/33]), and aortic valve (96% [23/24]). The pulmonary valve was more often both stenotic and insufficient (52% [37/71]) than purely regurgitant (30% [21/71]). In all cases, valve dysfunction was attributed to the presence of carcinoid plaques, which caused both thickening and retraction. Thickening was the result of both cellular proliferation and deposition of extracellular matrix. Proliferation of myofibroblasts was observed in all plaques and was mild in 49% (68/139) and moderate or severe in 51% (71/139). Extracellular matrix included collagen (in 99% of the 139 valves), myxoid ground substance (98% [136/139]), and elastin (20% [28/139]). Carcinoid plaques were also involved by neovascularization (94% [131/139]), chronic inflammation (94% [131/139]), and mast cell infiltration (64% [89/139]). Severe thickening was attributable primarily to collagen deposition in tricuspid valves and to myofibroblast proliferation and myxoid matrix in pulmonary valves. CONCLUSIONS: Among patients undergoing valvular surgery for carcinoid heart disease, tricuspid and pulmonary valves represented 92% of the excised valves (128/ 139). Although numerous cellular and extracellular features were common to the carcinoid plaques, variability in their relative expression produced appreciable differences in the histologic appearance among the plaques.

Adult↗

PubMed2002

Multiple cardiovascular complications in a patient with relapsing polychondritis.

Relapsing polychondritis is an uncommon disease of unknown etiology, usually manifested by inflammatory changes of cartilaginous tissues. Cardiovascular complications are rare but have been associated with adverse prognosis. Aortitis, vasculitis of large- and medium-sized arteries with aneurysm formation, valvulitis, pericarditis, and atrioventricular conduction disturbances have been reported as late complications of relapsing polychondritis. We describe a 42-year-old man who developed all the known cardiovascular complications of relapsing polychondritis except for clinically evident pericarditis. This case illustrates the multiple, varied, and potentially fatal cardiovascular complications that can occur with this disorder. Patients with relapsing polychondritis should be monitored closely for development of such complications.

Adult↗

PubMedDate not supplied

B-Lymphocytes in plaque and adventitia of coronary arteries in two patients with rheumatoid arthritis and coronary atherosclerosis: preliminary observations.

OBJECTIVES: To describe the subtypes of lymphocytes in coronary arteries of two patients with rheumatoid arthritis (RA) and coronary artery disease (CAD). MATERIALS AND METHODS: The Mayo Clinic database was searched for patients with RA and CAD who underwent an autopsy in 2001. Medical records were reviewed, and coronary arteries were examined microscopically. The percentage of B- and T-lymphocytes was determined using histomorphometry on representative sections stained with CD20 and CD3 antibodies, respectively. RESULTS: Two men were diagnosed with RA at ages 52 and 70 years and died at ages 60 and 82 years. One sustained an acute myocardial infarction 2 years prior to the diagnosis of RA and had stable CAD until an arrhythmic death. The other developed congestive heart failure secondary to ischemic heart disease 5 years after RA was diagnosed. Both patients had severe three-vessel CAD with both stable fibrocalcific plaques and acute lesions. B- and T-lymphocytes were identified in the plaque and adventitia of all coronary arteries. The mean percentage of B-lymphocytes was 37% to 52% in the plaque and 78% to 85% in the adventitia, while that of T-lymphocytes was 38% to 51% and 28%, for plaque and adventitia, respectively. CONCLUSIONS: In typical CAD, lymphocytic infiltrates are almost exclusively T-cells. In contrast, the two patients with RA and CAD showed prominent infiltrates of B-lymphocytes within plaques and adventitia. Thus, the leukocytic response in atherosclerotic plaques may be altered in patients with autoimmune disorders. This warrants further study.

Aged↗

PubMedDate not supplied

A light-hearted look at a lion-hearted organ (or, a perspective from three standard deviations beyond the norm). Part 1 (of two parts).

Throughout history, the heart has been associated not only with its life-sustaining function but also with its close ties to the human emotions. In this literature and Internet review, we attempt to gather and organize information from both of these perspectives as they relate to the heart in the following 11 categories: (1) fun facts, (2) medical photography, (3) history, (4) languages (etymology), (5) nonmedical English expressions, (6) death, (7) the arts, (8) movie titles, (9) song titles, (10) Shakespeare, and (11) the Bible. Part 1 will cover the first five topics, and Part 2 will cover the last six topics. These data may be useful to those who are engaged in teaching about the cardiovascular system.

Animals↗

PubMedDate not supplied

A light-hearted look at a lion-hearted organ (or, a perspective from three standard deviations beyond the norm) part 2 (of 2 parts).

Throughout history, the heart has been associated not only with its life-sustaining function but also with its close ties to the human emotions. In this literature and internet review, we attempt to gather and organize information from both of these perspectives as they relate to the heart in the following 11 categories: (1) fun facts, (2) medical photography, (3) history, (4) languages (etymology), (5) nonmedical English expressions, (6) death, (7) the arts, (8) movie titles, (9) song titles, (10) Shakespeare, and (11) the Bible. Part 1 (previously published) covered the first five topics, and Part 2 will cover the last six topics. These data may be useful to those who are engaged in teaching about the cardiovascular system.

Cardiology↗

PubMedDate not supplied

Primary synovial sarcoma of the mitral valve.

Primary cardiac synovial sarcoma is a rare malignancy, comprising approximately 5% of cardiac sarcomas and less than 0.1% of all primary cardiac tumors. Herein, we describe a synovial sarcoma arising on the anterior mitral leaflet in a 66-year-old man. The histopathologic diagnosis was supported by the immunohistochemical profile and the presence of the SYT-SSX1 fusion transcript identified by molecular genetic studies.

Aged↗

PubMedDate not supplied

Primary cardiac amyloidosis with 20-year survival.

BACKGROUND: The natural history of primary amyloidosis is poor, and for patients with symptomatic cardiac involvement, survival is generally less than 6 months. Even among treated patients with amyloid heart disease, survival beyond 5 years is rare. CASE REPORT: We report a patient with primary cardiac amyloidosis who is currently alive 20 years after his initial diagnosis. The extent and subtype of amyloid were documented by endomyocardial biopsy both at the time of initial diagnosis and 20 years later. To our knowledge, this is the longest survival ever reported for a patient with cardiac involvement by primary amyloidosis. CONCLUSION: The remarkably long stabilization of amyloid deposition in this patient may be attributed to early diagnosis, early institution of therapy, and, possibly, favorable genetic factors.

Adult↗

PubMedDate not supplied

Chloroquine cardiotoxicity: clinicopathologic features in three patients and comparison with three patients with Fabry disease.

BACKGROUND: Microscopic features of chloroquine cardiotoxicity are similar to those of Fabry disease. The purpose of the study was to compare clinicopathologic findings in both disorders. METHODS: Patients with a diagnosis of chloroquine cardiotoxicity or Fabry disease were identified who had undergone endomyocardial biopsy or autopsy at Mayo Clinic Rochester (1976-2000). Clinical information was collected from medical records and letters from referring physicians. Light and electron microscopy were performed in all cases. RESULTS: Three patients (two women, one man) with chloroquine cardiotoxicity ranged in age from 53 to 73 years. Chloroquine was given for rheumatoid arthritis in two and systemic lupus erythematosus in one. Three patients (two men, one woman) with Fabry disease ranged in age from 58 to 76 years. Two had angiokeratomas, but only one had a previous diagnosis of Fabry disease. All six patients presented with dyspnea. Light microscopy from all six revealed myocyte enlargement due to perinuclear vacuolization. By transmission electron microscopy, all six showed abundant myelinoid figures within involved myocytes. Curvilinear bodies were observed in two patients with chloroquine cardiotoxicity and in none with Fabry disease. CONCLUSIONS: Patients with cardiac dysfunction due to chloroquine cardiotoxicity or Fabry disease have similar ages, presenting clinical symptoms, cardiac light microscopy and sarcoplasmic myelinoid bodies ultrastructurally. Patients with Fabry disease may not have a personal or family history of the disease. Similarly, a history of chloroquine usage may not be known to the pathologist. In these settings, the presence of curvilinear bodies ultrastructurally is useful for the diagnosis of chloroquine cardiotoxicity.

Aged↗

PubMedDate not supplied

Surgical pathology of subaortic septal myectomy associated with hypertrophic cardiomyopathy. A study of 204 cases (1996-2000).

BACKGROUND: No large surgical series have qualitatively examined all histopathologic features of hypertrophic cardiomyopathy (HCM). METHODS: Medical records and microscopic slides were reviewed from 204 patients undergoing septal myectomy for HCM at Mayo Clinic Rochester. RESULTS: The 108 females and 96 males (1-86 years old; mean, 48) included 133 patients <60 years old (Group 1) and 71 patients > or =60 years (Group 2). Clinical features more prevalent in Group 2 than in Group 1 included female gender (68% vs. 45%; P=.003), aortic valve disease (31% vs. 12%; P=.01) and severe coronary atherosclerosis (43% vs. 9%; P=.001). Overall, microscopic abnormalities included myocyte hypertrophy (100%), endocardial (96%) and myocardial (93%) fibrosis, myocyte disarray (79%) and vacuolization (60%), endocardial inflammation (48%), arterial thickening (46%), dilated venules (28%), arterial dysplasia (16%), left bundle branch tissue (12%), infarction (2%), endocardial (1%) and myocardial (<1%) calcium, and amyloid (1%; senile type in all three). Lesions more prevalent in Group 1 than Group 2 were vacuolization (68% vs. 45%; P=.002), disarray (87% vs. 65%; P=.0003) and dilated venules (33% vs. 18%; P=.02). In contrast, lesions more frequent in Group 2 than in Group 1 included left bundle branch (20% vs. 8%; P=.02) and amyloid and endocardial calcium (4% vs. 0%; P=.04, each). CONCLUSIONS: Among patients undergoing septal myectomy for HCM, 53% were women and 35% were >/=60 years old. The most common microscopic features were hypertrophy, disarray, fibrosis, inflammation and vascular alterations. Disarray cannot be used as a morphologic hallmark for HCM in small surgical myectomy specimens because it was absent in 21% of the patients. Because amyloid unexpectedly affected three elderly patients, routine amyloid staining is recommended for patients >/=65 years old.

Adolescent↗

PubMedDate not supplied

Surgical pathology of subaortic septal myectomy not associated with hypertrophic cardiomyopathy: a study of 98 cases (1996-2000).

BACKGROUND: No series have described the surgical pathology of subaortic septal myectomy in patients with conditions other than hypertrophic cardiomyopathy (HCM). METHODS: Medical records and microscopic slides were reviewed from 98 non-HCM patients undergoing septal myectomy at Mayo Clinic Rochester from 1996 to 2000. Concurrently, 204 other patients had myectomy for HCM. RESULTS: The study group (65 women, 33 men) ranged in age from 1.5 to 92 years (mean, 61). Seventy underwent surgery for aortic stenosis (Group 1), 25 for congenital subaortic stenosis (Group 2) and 3 for other conditions (Group 3). Group 1 patients were older than Group 2 patients (72 vs. 26 years; P<.0001). Microscopic evaluation showed myocyte hypertrophy (97%), vacuolization (35%), left bundle branch tissue (26%) (33% in Group 1 vs. 8% in Group 2; P=.02) and disarray (19%); interstitial fibrosis (92%), inflammation (10%) and amyloidosis (7%, all prealbumin type, all Group 1, >80 years old); arterial thickening (18%) and dysplasia (12%), and dilated venules (6%); and endocardial fibrosis (74%) (64% in Group 1 vs. 100% in Group 2; P=.0001) and chronic inflammation (17%). CONCLUSIONS: Of 302 patients undergoing subaortic septal myectomy, 32% had conditions other than HCM. Myocyte disarray was present in 19% of patients without HCM (and was absent in 21% of HCM patients in a companion study). Thus, disarray alone cannot be used reliably to include or exclude a diagnosis of HCM in small surgical specimens. Because amyloid was found unexpectedly in seven elderly patients, we recommend routine amyloid staining on surgical myectomy tissue from patients >/=65 years old.

Adolescent↗