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Biomedical subjects

A Saxe

Publications and source records attributed to A Saxe.

At least 19 recordsLinked to original sources
PubMed2001

Role of sample adequacy in fine needle aspiration biopsy of palpable breast lesions.

BACKGROUND: The role of fine needle aspiration biopsy (FNAB) in breast lesions remains uncertain because its accuracy has been questioned. We hypothesized that this is related to failure to define standards for adequacy of sample preparation. METHODS: We reviewed cytology and pathology reports from 351 patients undergoing FNAB at a 350-bed community, university-affiliated teaching hospital over a 2-year period. Patients were included if they had an open biopsy within 2 years of an FNAB of the same lesion. Cytology reports were reviewed by a cytopathologist unaware of the clinical setting or subsequent histology; surgeons unaware of the cytology reports reviewed histology reports. Cytological diagnoses were benign, likely benign, probable cancer, and definite cancer. Samples were characterized as satisfactory, less than optimal (few mammary epithelial clusters), or inadequate (no mammary epithelial clusters.) We assessed the proportion of inadequate samples, the accuracy of FNAB, and the influence of sample adequacy upon FNAB sensitivity. RESULTS: Ninety-nine (28%) FNABs were inadequate, 77 (22%) less than optimal, and 175 (50%) satisfactory. Ninety-five patients (27%) had a final diagnosis of malignancy. FNABs classified as satisfactory or less than optimal and characterized as benign (n = 102) had a negative predictive value (NPV) of 0.91; those termed definite cancer (n = 43) had a positive predictive value (PPV) of 0.98. Only 10% of all cancers were identified in the 28% of FNABs that were classified as inadequate (P <0.01). CONCLUSIONS: We concluded that too few FNABs are performed in a fashion that permits definitive cytological interpretation. Inadequate FNABs are less likely to detect malignancy. After excluding inadequate preparations, FNABs interpreted as definite cancer and as benign are highly accurate in identifying patients with and without cancer.

Biopsy, Needle↗
PubMed2001

Laparoendoscopic approaches to occult gastrointestinal bleeding.

Identification of sites of small bowel hemorrhage remains a difficult problem. Endoscopy performed in association with surgery often proves successful when other attempts have failed. In attempts to minimize morbidity and even increase accuracy, surgeons have explored combining laparoscopic techniques with endoscopy. Although published experiences remain few, expectations remain high.

Endoscopy, Gastrointestinal↗
PubMed1999

Relationship between method of detection of breast cancer and stage of disease, method of treatment, and survival in women aged 40 to 49 years.

The optimal breast cancer screening program for women 40 to 49 years of age remains controversial. To help assess the value of screening mammography for this age group, we studied the relationship between the method of breast cancer detection and stage, therapy, and survival. Cases of breast cancer diagnosed at Sinai Hospital (Detroit, MI) between January 1985 and December 1994 were reviewed. A total of 181 cases involving 40- to 49-year-old women were available for analysis. The distribution of stage of disease significantly differed among the three methods of detection (P<0.0001). Breast-conserving surgery was more commonly performed in cases detected by screening mammography and clinical breast examination than in cases detected by breast self-examination (P = 0.001). Variation in the stage of disease resulted in improved survival for cases detected by screening mammography and clinical breast examination when compared with those detected by breast self-examination (P = 0.019). Women diagnosed with breast cancer between the ages of 40 and 49 years had earlier stage disease, were more likely to be treated with breast-conserving therapy, and had better survival if their disease was first recognized by screening mammography. Screening mammography has an important role for women of this age.

Adult↗
PubMed1997

Cholecystogastrocolonic fistula with intrahepatic abscess: a rare complication of biliary stone disease.

A 52-year-old woman exhibited both a cholecystogastrocolonic fistula and intrahepatic abscess. Biliary-enteric fistulas are unusual complications of gallstone disease, and multiple, complex fistulas are extremely uncommon. Hepatic abscesses are also unusual complications of gallstone disease. The combination of a complex biliary-enteric fistula and hepatic abscess arising from gallstone disease has not been reported. In our patient, surgery was prompted by the hepatic abscesses; the fistula was not recognized preoperatively. We elected to resect gallbladder, gastric antrum, and transverse colon en bloc with primary closure of the gastric defect and, because the colon had not been "prepped," we created a right transverse colostomy and left mucus fistula. Under ideal circumstances, the anatomy of biliary fistulas is characterized preoperatively and managed definitively with a single procedure.

Biliary Fistula↗
PubMed1997

Parathyroid hormone and parathyroid hormone-related peptide in venous umbilical cord blood of healthy neonates.

Objective of this study was to assess the role umbilical cord serum parathyroid hormone (PTH), and parathyroid hormone-related peptide (PTH-RP) may play in maintaining the maternal-fetal calcium (Ca) gradient. PTH and PTH-RP and total and ionized Ca levels were measured in blood samples of 20 neonates immediately after birth. Maternal peripheral blood total Ca was measured simultaneously. Mothers were free of hypertension, diabetes or Ca disorders. Neonates were healthy term babies with Apgar scores of eight or greater at one and at five minutes post delivery. PTH was measured using an immunoradiometric double antibody assay that recognizes intact PTH (1-84). PTH-RP was measured by an immunoradiometric double antibody assay that recognizes only PTH-RP (1-74). There was no overlap between the two assays. Ca levels in the neonates were higher than those in their mothers (p < 0.01), confirming a maternal-fetal Ca gradient. However in 18 out of 20 neonates PTH levels in cord blood were below the detection limit (3 pg/ml) and PTH-RP levels also were below detection limit (0.2 pmol/L). PTH-RP and PTH levels in the other two neonates were 0.5 and 0.6 pmol/L (PTH-RP) and 3 pg/ml (PTH) which are in the low normal range for normal adults. We conclude that these data do not support a role for either PTH or PTH-RP in venous cord blood in maintaining the maternal-fetal Ca gradient. They are, however, compatible with a paracrine role for these hormones.

Calcium↗
PubMed1996

Effect of patient position upon success in placing central venous catheters.

BACKGROUND: There is little consensus regarding the most efficient or the safest method by which to place a central venous catheter (CVC). METHODS: A single house officer prospectively evaluated 140 patients for whom he was requested to place CVCs. One hundred and eight patients participated in a randomized study of positioning. Of the 140 patients, 7 had emergency line placement; 105 randomized patients undergoing elective CVC placement form the basis for this report (power > 80% to detect change of one needle pass between groups). Patient positions were termed "bump" (head turned to the contralateral side and a rolled towel placed vertically between the scapulas) and "no bump" (head facing forward and no towel placed in the back.) RESULTS: Ninety-three of 105 patients had successful catheter placement. Catheters were more often successfully introduced in the bump group than no bump group (98% versus 83%, P < 0.04). For patients with difficult CVC placement (those > 160 pounds, those with a weight-to-height ratio > 29, those with previous unsuccessful catheterization), the bump position was superior with respect to increased likelihood of venous blood return, decreased likelihood of arterial blood return, and increased likelihood of successful catheterization, although differences did not reach statistical significance (P < 0.05) in individual analyses. Of patients with successful catheterization, 97% had three or fewer needle passes. Those with more than three needle passes were less likely to have successful catheter placement (P < 0.01), were more likely to have arterial blood return (P < 0.01) and pneumothorax (P = 0.12). CONCLUSIONS: The bump position improves the likelihood of successful central venous catheter placement. No more than three needle passes ought to be attempted.

Aged↗
PubMed1995

Effects of long-term lithium infusion on normal parathyroid tissue.

BACKGROUND: Approximately 10% of patients taking lithium for manic-depressive disorders become hypercalcemic. It remains unclear whether lithium initiates disease or promotes underlying hyperparathyroidism. We have previously demonstrated that at therapeutic concentrations lithium stimulates in vitro incorporation of both tritiated thymidine and bromodeoxyuridine into abnormal human parathyroid tissue, reflecting growth-promoting properties. Whether lithium has similar growth-promoting properties in normal parathyroid tissue remains unresolved. METHODS: We infused lithium (0 mmol/L, 3 mmol/L, or 10 mmol/L) through implantable subcutaneous pumps into normal rats for 3 months and measured levels of serum lithium, serum calcium, and serum parathyroid hormone (PTH) (with a radioimmunoassay specific for rat PTH 1-34.) On completion of the infusion, bromodeoxyuridine (30 mg/kg) was administered intraperitoneally. The parathyroid glands were removed and measured in two dimensions to calculate gland volume [V = (pi/6) x (d1) x (d2)2.] Parathyroid incorporation of bromodeoxyuridine was assessed by using immunocytochemistry. RESULTS: Serum lithium level was significantly (p < 0.05) different between groups and constant within groups. Levels of serum calcium and PTH were inversely related to each other; however, no significant differences were noted between groups with respect to level of serum calcium or serum PTH at any measurement. Similarly, no significant differences were noted between groups with respect to gland size or number of bromodeoxyuridine-positive cells. CONCLUSIONS: Long-term lithium infusion in rats for a period representing approximately 15% of their life span failed to evoke changes in parathyroid gland size or function. These data are consistent with (1) lithium as a promoter of hyperparathyroidism and (2) resection of abnormal parathyroid tissue and resumption of lithium for patients requiring long-term therapy.

Animals↗
PubMed1994

Laparoendoscopy (laparoscopy assisted enteroscopy) and partial resection of small bowel.

We investigated laparoendoscopy (laparoscopy-assisted small bowel enteroscopy) as an aid in managing the challenging diagnostic problem of occult small bowel hemorrhage. We performed laparoendoscopy on five nonconditioned dogs and five conditioned dogs. In each case, we laparoscopically inspected the small bowel from the ligament of Treitz to the ileocecal valve. Small bowel was exteriorized, an enterotomy was performed, and an Olympus CL-100L colonoscope was inserted and advanced proximally to the stomach and distally to the ileocecal valve. A segment of small bowel was arbitrarily designated as the site of bleeding, was exteriorized, and was resected. Bowel continuity was restored with a stapled anastomosis. The animals were euthanized and autopsied immediately after the procedure (n = 5) or a week following the procedure (n = 5), at which time the anastomoses were tested for leakage and patency. The entire small bowel was visualized in all animals. There were no anastomotic leaks. Laparoendoscopy may be of value in identifying and treating hemorrhagic origin of small bowel. Clinical trials are warranted.

Anastomosis, Surgical↗
PubMed1993

Effect of lithium on incorporation of bromodeoxyuridine and tritiated thymidine into human parathyroid cells.

OBJECTIVE: To measure lithium chloride-stimulated incorporation of tritiated thymidine (3H-TdR) and bromodeoxyuridine (BrdU) by human parathyroid cells as an indicator of lithium's growth-promoting properties. DESIGN: Cell suspensions derived from abnormal human parathyroid tissue were incubated for 5 days with graded concentrations of lithium and pulsed with either 0.074 MBq of 3H-TdR or 0.6 microgram of BrdU. The 3H-TdR incorporation was measured by counting cell filtrates in a beta counter, and nuclear BrdU incorporation was determined by counting nuclei positively stained by an antibody to BrdU. Counts of BrdU-positive cells by two observers unaware of incubation conditions were correlated with 3H-TdR counts. RESULTS: Cell suspensions derived from adenomatous and hyperplastic parathyroid glands demonstrated a dose-related increase in 3H-TdR incorporation. There was close correlation between the two observers' counts of BrdU-positive cells (r = 0.70, P = .01) and between each observer's counts and 3H-TdR counts (r = 0.70, P = .02, and r = 0.90, P = .01, respectively). CONCLUSIONS: Lithium stimulates in vitro incorporation of 3H-TdR and BrdU by abnormal human parathyroid cells, consistent with a growth-promoting effect.

Adenoma↗
PubMed1993

Laparoscopic cholecystectomy in patients aged 65 or older.

Laparoscopic cholecystectomy is replacing open cholecystectomy in the surgical management of gallstone disease in healthy individuals. However, the role of laparoscopic cholecystectomy in patients thought to be at higher risk for surgical morbidity is still being defined. The course of patients aged 65 or greater who underwent attempted and successful laparoscopic cholecystectomies were reviewed. Eleven patients (12%) were converted from laparoscopic to open cholecystectomy. For the 83 patients completing laparoscopic cholecystectomy, the median time of surgery was 115 min and the median length of postoperative stay was 1 day. Two patients required parenteral analgesia longer than 48 h. Seven patients were admitted and monitored postoperatively, although five of these were preoperatively planned. Five patients were readmitted within 30 days. One patient was admitted with a myocardial infarction, one a subphrenic abscess, one an incarcerated hernia, one with pyrexia and leukocytosis (for which no source was identified), and one for an elective urinary tract procedure. Laparoscopic cholecystectomy provides patients aged 65 or older the same benefits of shorter hospital stay and less pain than it provides younger patients. Age alone should not be a contraindication to attempted laparoscopic cholecystectomy.

Age Factors↗
PubMed1993

Incidentally discovered adrenal tumors.

The introduction of computed tomography has dramatically increased the detection and in turn the incidence of incidentally identified adrenal abnormalities; the current incidence rate is approximated at 2%. Improvements in technology can be expected to increase the reported incidence even further and magnify the clinical problem these abnormalities pose. Although most clinicians would agree that surgery is indicated in patients with primary adrenal malignancy and those with significant endocrine function, strategies for the management of patients with incidentally identified lesions remain controversial. One approach is to base the risk of primary adrenal malignancy on lesion size and undertake biochemical evaluation only for patients who, on clinical grounds, are likely to have endocrinopathy. Another approach is to assess endocrine function (biochemically and radiographically) in all patients and recommend surgery or additional evaluation (eg, needle biopsy) for those found to have abnormalities. Recent studies of patients with benign, incidentally discovered adrenal lesions suggest that these common lesions are almost all hormonally functional to some extent. The natural history of subclinical but functioning adrenal adenomas is not known.

Adenoma↗
PubMed1993

A two-person, two-handed technique for laparoscopic cholecystectomy.

This manuscript describes a technique of laparoscopic cholecystectomy which permits the surgeon to use both hands. The technique can be modified to accommodate both right- and left-handed surgeons. Advantages we have appreciated in performing over 100 procedures in this manner include a less crowded operating environment, a less costly operating team, and a resident assistant closer to the patient with two hands available so that he or she can better develop the co-ordination necessary to assume increasing responsibility for the procedure.

Cholecystectomy, Laparoscopic↗
PubMed1991

Genetic markers in thyroid tumors.

Tissue from nine patients with malignant tumors and two with benign tumors was cultured briefly before cytogenetic analysis. The tumors included one goiter and one Hürthle cell adenoma, one lymphoma, one medullary carcinoma, two Hürthle cell cancers, and five papillary cancers, varying widely in clinical staging and histologic differentiation. When assessed, DNA content was aneuploid in two of six malignant tumors. Various culture conditions (oxygen levels, dissociation methods, and media) were evaluated; the end points were growth, cell differentiation, and time to first harvest. Clonal aberrations were detected in one of four successfully harvested papillary cancers: they consisted of trisomy 7 and a rearrangement of chromosome 10. The rea (10) seen in 22 of 27 cells involved bands q11-21. Two other papillary tumors and a medullary cancer (a family member with multiple endocrine neoplasia type IIA) showed tetraploidy and nonclonal numerically aberrant cells. A lymphoma and two benign lesions showed no cytogenetic abnormality. The tumor with rea (10) is of special interest because abnormalities of 10q have been reported repeatedly in thyroid tumors, including two cases of papillary thyroid tumors with a structural aberration similar to that of the presented case. This rearrangement could affect the ret-proto-oncogene, localized to 10q11.2 which is activated in some papillary thyroid carcinomas.

Adult↗
PubMed1985

Serum calcium metabolism in acute experimental pancreatitis.

Serum calcium changes in severe pancreatitis were studied in 23 dogs. Twelve dogs underwent duodenotomy and served as controls. Pancreatitis was induced in the other 11 by autologous bile injection (1 ml/kg) into the pancreatic duct. Serum amylase, total calcium, ionized calcium, albumin, magnesium, chloride, phosphorous, parathyroid hormone (PTH), and calcitonin were measured at 0, 1/2, 1, 3, 6, 24, 48, and 72 hours after duodenotomy or bile injection. Serum amylase levels became significantly elevated in all dogs with pancreatitis at 30 minutes (p less than 0.01) and remained so throughout the entire experiment. Total calcium levels dropped significantly 30 minutes after pancreatitis was induced from 10.0 +/- 0.3 mg/dl compared with 8.8 +/- 0.4 mg/dl in control dogs (p less than 0.05) and remained statistically lower for as long as 1 hour. Ionized calcium levels were significantly lower than were those of control dogs at 1/2, 1, 3, and 6 hours (p less than 0.05). Serum magnesium and chloride levels showed no significant changes between both groups. The only significant difference in phosphorus values was at 6 hours when they were higher in dogs with pancreatitis than in controls (6.2 +/- 0.3 mg/dl versus 4.8 +/- 0.4 mg/dl; p less than 0.05). Serum albumin levels remained unchanged throughout the study except for 48 hours when they were significantly lower in animals with pancreatitis (p less than 0.02). PTH levels were significantly greater in dogs with pancreatitis than in controls at 1, 3, 6, and 24 hours (p less than 0.05). There was no significant difference in calcitonin levels between both groups. Ionized calcium is a more reliable indicator of calcium fluxes in acute experimental pancreatitis since it remains depressed longer than total serum calcium. The time course of PTH elevation indicates a reaction to hypocalcemia, and failure of PTH secretion is not the cause of hypocalcemia in pancreatitis. This study does not support elevation of calcitonin as a cause of hypocalcemia in acute pancreatitis.

Acute Disease↗