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Z Kaufman

Publications and source records attributed to Z Kaufman.

At least 19 recordsLinked to original sources
PubMed1998

Aberrant crypt foci in human colons: distribution and histomorphologic characteristics.

Aberrant crypt foci (ACF) are one of the earliest putative preneoplastic, and in some cases, neoplastic lesions in human colons. These microscopic lesions, identified on methylene blue-stained mucosa with a low-power-magnification microscope, are thought to be closely related to the earliest steps in multistage colonic tumorigenesis. We investigated the distribution pattern and histomorphological features of ACF in 74 patients with sporadic colorectal cancer. The distribution pattern shows a slightly higher prevalence with older age. The prevalence of the ACF in sigmoid colon was significantly higher in patients with colorectal cancer as compared with patients with benign colonic diseases. Also, significantly more ACF were detected in distal parts of the large bowel (descending, sigmoid colon, and rectum) than in proximal parts. Of 42 microdissected lesions, 12 were dysplastic and 30 were hyperplastic foci. The average size of dysplastic lesions was significantly larger than hyperplastic foci. More apoptotic bodies were found in dysplastic lesions. These lesions also showed an upward expansion of proliferative compartment and higher proliferation indices expressed as proliferating cell nuclear antigen-labeling index. Lymphoid follicles were frequently observed in the base of both hyperplastic and dysplastic foci (40% and 66.6%, respectively). The coincidence of lymphoid follicles was 2.5 to 8 times higher than expected. These features may be related to further progression of selected ACF during colorectal tumorigenesis.

Adult↗
PubMed1997

Proliferating cell nuclear antigen as a marker of cell kinetics in aberrant crypt foci, hyperplastic polyps, adenomas, and adenocarcinomas of the human colon.

BACKGROUND: One of the first steps in multistage colonic carcinogenesis is increased cell proliferation and an upward shift of the proliferation zone of colonic crypts. In the present study, progression in cell kinetics was followed up at all sequential stages of colonic carcinogenesis, starting with aberrant crypt foci (ACF), the earliest putative preneoplastic lesions, hyperplastic and dysplastic polyps, and invasive carcinomas. MATERIALS AND METHODS: Colonic tissue and tumor specimens were prospectively obtained from 65 patients treated at our hospital for adenocarcinoma or malignant polyps. For identification of ACFs, dissected mucosal strips obtained from patients with colorectal cancer were stained with 0.1% methylene blue and scanned under dissecting microscope. Paraffin-embedded ACFs and macroscopic lesions were serially sectioned, deparaffinized, and stained with a monoclonal antiproliferating cell nuclear antigen (PCNA) antibody. The PCNA-labelling index (PCNA-LI), expressed as a ratio of positively stained nuclei to total nuclei counted, was calculated separately for basal, middle, and upper colonic crypt compartments. A comparison of the PCNA-LI was made for each compartment in normal mucosa, and hyperplastic and dysplastic lesions. RESULTS: A stepwise increase in the PCNA-LI was observed during neoplastic progression of colonic lesions. The two most important variables of increased cell proliferation, expressed as PCNA-LI per crypt compartment, were the presence of dysplasia and the size of dysplastic lesions. CONCLUSIONS: In colorectal carcinogenesis, hyperproliferation with upward expansion of proliferative compartment is a characteristic feature at all stages of malignant progression.

Adenocarcinoma↗
PubMed1997

Pernicious anemia and adenocarcinoma of the stomach in an adolescent: clinical presentation and histopathology.

Primary gastric-carcinoma accounts for only 0.05% of pediatric gastrointestinal malignancies. Although elderly patients who have pernicious anemia are at greater risk of the development of atrophic gastritis and gastric carcinoma, pernicious anemia caused by vitamin B12 deficiency is extremely rare in otherwise healthy adolescents. The authors present a 14.5-year-old boy who had dimorphic anemia caused by vitamin B12 and iron deficiencies in whom atrophic gastritis and gastric carcinoma developed. To the best of our knowledge, this association has not been previously reported in children or adolescents.

Adenocarcinoma↗
PubMed1996

[Occupation and bladder cancer].

The proportion of all cancers attributed to occupational environment has been estimated at only 4% (range 2-8%), although 20% of bladder carcinoma is occupationally related. In Israel, 7 substances have been established as bladder carcinogens and another 2 are suspected. The linkage between bladder cancer and occupation was examined according to occupational history and work-place exposure; smoking habits were also noted. The study population consisted of 1230 patients diagnosed as suffering from bladder cancer in 1988-1993 in 5 central hospitals; 80% were men, mean age 68.9 +/- 10.8 years. Only 41% of the files (mean 45%, range 13-69%) had information about last job, but no information on exposure. The information in 226 files out of 500 (45%) about previous occupations indicated potential association with bladder cancer in 68%. These occupational fields were: medicine (doctors, nurses), building and agriculture, and comprised 27.6% of all jobs reported. Other occupations connected with bladder cancer reported with lesser frequency were in the paint, rubber, textile and leather industries. There was information about smoking, a known carcinogen for bladder cancer, in only 59% of the files. Our findings indicate that the overall situation in Israel is similar to that in other countries. There is a connection between bladder cancer and exposure to carcinogens at work, but the medical files were not a good source of information regarding the precise extent of this problem. Recording occupational history is important for proper medical surveillance of high risk populations, for early detection of bladder cancer, and for prevention of further exposure.

Aged↗
PubMed1996

DNA--protein crosslinks, a biomarker of exposure to formaldehyde--in vitro and in vivo studies.

Formaldehyde (FA) is a widely produced industrial chemical. Sufficient evidence exists to consider FA as an animal carcinogen. In humans the evidence is not conclusive. DNA-protein crosslinks (DPC) may be one of the early lesions in the carcinogenesis process in cells following exposures to carcinogens. It has been shown in in vitro tests that FA can form DPC. We examined the amount of DPC formation in human white blood cells exposed to FA in vitro and in white blood cells taken from 12 workers exposed to FA and eight controls. We found a significant difference (P = 0.03) in the amount of DPC among exposed (mean +/- SD 28 +/- 5%, minimum 21%, maximum 38%) than among the unexposed controls (mean +/- SD 22 +/- 6%, minimum 16%, maximum 32%). Of the 12 exposed workers, four (33%) showed crosslink values above the upper range of controls. We also found a linear relationship between years of exposure and the amount of DPC. We conclude that our data indicate a possible mechanism of FA carcinogenicity in humans and that DPC can be used as a method for biological monitoring of exposure to FA.

Biomarkers↗
PubMed1995

Mastectomy as the preferred treatment for breast cancer among new immigrants from the former USSR.

Sixty-four new immigrant patients with primary breast cancer who arrived in Israel since 1990 were compared to 322 Israeli women with primary breast cancer. New immigrant patients had a more advanced stage at diagnosis (stage III+IV 28% vs. 13% respectively, P = 0.00005); larger mean tumor size (3.08 +/- 1.7 cm vs. 2.25 +/- 1.4 cm respectively, P = 0.00002); and more involved lymph nodes (3.8 +/- 5.3 vs. 1.8 +/- 3.3 P = 0.0002). Forty-seven percent of new immigrants had breast-conserving surgery compared to 69% of the Israelis (P = 0.0004). In stage II 51% of the new immigrants had conservative surgery compared to 74% in the Israeli group (P = 0.03). Mastectomy was recommended to 39 Israeli patients and to six immigrants. Only 19% of the Israeli group requested mastectomy compared to 44% in the new immigrant group. Most of the new immigrant patients chose mastectomy although breast-conserving surgery was an equal alternative. The reasons for choosing mastectomy as the preferred mode of treatment were related to economic problems, different life concepts, and other priorities. Constant surveillance and considerable enlightenment are needed in the new immigrant population, so that they will be able to separate the disease and its treatment from their paramedical problems.

Breast Neoplasms↗
PubMed1995

Acute cholecystitis in diabetic patients.

Postoperative outcome and severity of acute cholecystitis in 32 diabetic patients (DM) who underwent urgent cholecystectomy were compared on a case-control basis with 32 nondiabetic age/sex matched controls. There was no difference in incidence of renal and lung diseases or duration of acute symptoms before surgery. Cardiovascular diseases were more often seen in the diabetic group (16/32 in DM, 7/32 in controls, P = 0.03). Bactobilia was more often in diabetics (19 in DM, 11 in controls, p = 0.07). Postoperatively, there was a trend toward higher incidence in overall complication rate. Infectious complications (wound and respiratory infections, hepatic abscess) were higher in DM, although the difference was not statistically significant. One patient in DM group died as a result of multiorgan failure. There was no difference in total and postoperative hospital stay. The severity of acute cholecystitis was greater in diabetics (26 patients with moderate-to-severe cholecystitis in DM group, 18 in control group, P = 0.05). The study indicates that although pathological findings were more severe in DM group, the postoperative course is comparable in diabetics as compared to age and sex matched nondiabetic controls. Our findings justify reconsideration of prophylactic cholecystectomy in asymptomatic diabetic patients.

Acute Disease↗
PubMed1995

Massive gastrointestinal bleeding caused by Dieulafoy's lesion.

Dieulafoy's lesion is an anomaly, difficult to diagnose, consisting of an abnormally dilated submucosal gastric blood vessel that can cause life-threatening gastric hemorrhage. Five patients with Dieulafoy's lesion and massive gastrointestinal bleeding are described. The diagnosis was made by endoscopy in two patients and during operation in the other three. On endoscopy the source of bleeding was localized to the stomach in all patients. This information was important for the operative approach. Conservative treatment failed to prevent rebleeding, and all patients required surgery. In three patients excision of the lesion was performed, and suture only in the other two. The difficulties in diagnosis of the lesion and the surgical options are discussed.

Adult↗
PubMed1994

Triple approach in the diagnosis of dominant breast masses: combined physical examination, mammography, and fine-needle aspiration.

In an attempt to reduce the number of breast biopsies done for benign breast disease in patients with breast lumps, we evaluated prospectively the sensitivity and specificity of the combination of three diagnostic modalities: clinical examination, mammography, and fine-needle aspiration cytologic examination (FNA). A total of 234 patients with a breast mass had a physical examination, a mammogram, and FNA, and were listed as malignant/suspicious or benign. All patients underwent a subsequent biopsy: 110 were found to have breast cancer, and 124 had a benign lesion. The sensitivity and specificity of the individual tests were as follows: 89% and 73%, respectively, for mammographic examination; 93% and 97% for FNA cytologic examination; and 89% and 60% for physical examination. For the combined triad of tests, the sensitivity was 100% and specificity 57%. All patients who had breast cancer had positive findings for malignancy in one or more of the diagnostic tests, i.e., 100% sensitively. All patients who had negative findings for malignancy in all three diagnostic tests had benign lesions, i.e., a negative predictive value of 100%. We conclude that breast masses can be diagnosed with a high degree of accuracy by combined physical, mammographic, and fine-needle aspiration cytologic examination. Patients in whom physical examination, mammography, and FNA were negative for malignancy can be safely observed, obviating the need for an open biopsy.

Adult↗
PubMed1993

[Changes in diagnosis and treatment of breast pathology at a specialized breast clinic].

The following results highlight the changes that occur when breast pathology is diagnosed and treated at a centralized breast clinic. 2 periods of 1 year each were compared. During the first year breast problems were treated in a general surgical clinic. During the second year all breast problems were diagnosed and treated in a specialized breast clinic, in which a surgeon, radiologist, pathologist and oncologist participated as a team. During the second year 81 patients were operated for breast cancer compared to 56 in the first year and to a mean of 41 in previous years. The rate of lumpectomies in the second year was 60% compared to 45% in the first. A similar number of patients with palpable findings presented in both years and there were 295 fine needle aspirations in the first year vs 290 in the second. Fewer biopsies were done for benign palpable lesions in the second year (28 vs 79) due to better interpretation of benign cytological and mammographic findings. Since diagnosis of the tumor prior to surgery was more accurate in the second year, a more specific consultation with the patient was possible. Treatment options were discussed in greater detail and the patient could therefore participate in the treatment process. The number of fine needle localization biopsies (FNLB) done during the second period was 46, compared to 15 in the first period. Good collaboration between surgeon and radiologist explains the increase in the rates of malignancies found in FNLB in the second period (50% vs 33%).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care Facilities↗
PubMed1993

Side-effects of screening.

There has been a 42% increase in the number of mammograms performed outside the national screening programme (operating in Camberwell, southeast London) which was not anticipated in the Forrest Report, a document to the Health Ministers of the U.K. by a working group chaired by Sir Patrick Forrest. The report compiles recommendations on breast screening, using mammography and breast self-examination, to reduce the mortality in women aged 50-64 years. This 42% increase is attributable mainly to referrals from menopause clinics and general practitioners of patients mainly in the screening age group. When we looked at referrals from general practitioners, suspicious mammographic findings were reported in 20% of patients referred with a breast lump, in contrast to only 4% of patients referred with breast pain or nodularity. Better education of both the public and general practitioners, concerning the signs and symptoms of breast cancer, may reduce demands to perform mammographies outside the current national screening programme.

Ambulatory Care Facilities↗
PubMed1992

Breast masses in adolescent females.

In a retrospective study of 38 adolescent females operated on for mammary masses, 42 fibroadenomata (FA), 2 fibrous scars around abscesses, and one papilloma were found. All were postmenarchal. Clinical and pathological features were reviewed and the patients reexamined or interviewed. FA were mostly asymptomatic and removed a few weeks after incidental discovery. They were often seen in Jewish girls of parents born in North Africa and the Middle East, and were more frequently located in the outer superior quadrant of the left breast. New FA appeared in almost half of the cases later on in the same breast, as well as in the other breast, or bilaterally. Necrosis occurred in three FA and was unrelated to the size of the tumor. There was no correlation between the size of FA, multiplicity, or necrosis, nor between increased stromal or epithelial atypia, cellularity, or mitotic activity. One explanation for the high rate of multiplicity might be related to this neoplasm occurring in an actively developing organ under hormonal control. There was no increased breast carcinoma apparent in the family history. Therefore, except in cases of fast-growing tumors, a conservative approach is recommended because of the frequency of multiple FA as well as aesthetical postoperative complications.

Adenofibroma↗
PubMed1991

Fibrous mastopathy in insulin dependent diabetics.

The cases of two poorly controlled insulin dependent diabetic women, presenting with hard discrete breast lumps clinically suspicious of carcinoma are presented. Mammography revealed dense dysplastic parenchymal changes with no specific features of carcinoma and ultrasound showed acoustic shadowing but no discrete mass. Excision biopsy of these lumps was performed. Histologically they were benign, and were composed of fibrous tissue with a chronic inflammatory cell infiltrate. With better awareness of fibrous mastopathy which can occur in this group of diabetic patients, and with the absence of specific radiological features of malignancy, some of these women may be observed and spared excision biopsy.

Adult↗
PubMed1991

The mammographic parenchymal patterns of nulliparous women and women with a family history of breast cancer.

One-hundred-and-thirteen mammograms of nulliparous women and 44 mammograms of women with a family history of breast cancer were graded according to Wolfe's parenchymal pattern classification. These were compared to 437 mammograms of women without these risk factors. Mammograms were read by two independent observers in order to evaluate inter- and intra-observer variation. The interobserver variation was reduced from 17% to 5% by combining high risk patterns (P2 and DY) and low risk patterns (N1 and P1). A significantly higher proportion of high risk patterns was found in nulliparous women compared to parous women (P less than 0.01). The proportion of high risk patterns decreased significantly with the number of children (P less than 0.01). Women with a family history of breast cancer had almost the same parenchymal patterns as women without a family history. In conclusion, while nulliparity and family history are recognized risk factors for developing breast cancer, only nulliparity would appear to influence the mammographic parenchymal pattern. This probably reflects the different mechanism by which the two factors affect breast tissue.

Breast Neoplasms↗
PubMed1991

The mammographic parenchymal patterns of women on hormonal replacement therapy.

In this study 383 mammograms of women on hormone replacement therapy (HRT) for more than one year and 216 mammograms of women performed before HRT was started were examined to identify any mammographic features which are associated with a higher incidence of developing breast cancer according to Wolfe's criteria. There was no significant difference in the proportion of high and low risk parenchymal patterns as the duration of HRT increased. A significantly higher proportion of low risk patterns with ageing was observed in 216 women who had never been on HRT when compared to 194 mammograms of women who had been on HRT for more than 5 years. This difference becomes more obvious in women on HRT with less than three children compared to a similar group not taking HRT. Women who had not taken HRT appeared to undergo normal involutional changes which were reflected by an increase in the proportion of low risk patterns with increasing age. We may conclude from these findings that HRT appears to inhibit involutional processes within the breast and therefore this group have higher risk parenchymal patterns for a longer period of time and subsequently may have a higher risk of developing breast cancer.

Age Factors↗
PubMed1990

[Metastatic malignant melanoma of the small bowel as a surgical emergency].

2 cases of metastasis of malignant melanoma to the small bowel presenting as surgical emergencies due to obstruction, are reported. In both cases there was no other evidence of metastatic spread at the time of surgery. Segmental resection of involved bowel was performed, providing satisfactory palliation. This reinforces the opinion that surgical resection of symptomatic metastases of malignant melanoma to the small bowel is justified, despite the poor prognosis of the disease itself.

Female↗