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Biomedical subjects

D L Page

Publications and source records attributed to D L Page.

At least 235 records · Page 13Linked to original sources
PubMed1978

Relation between component parts of fibrocystic disease complex and breast cancer.

Specimens of benign breast disease obtained from biopsies performed at Vanderbilt Hospital (Nashville, Tenn.) between 1952 and 1959 were histologically reviewed and characterized as to individual component types of fibrocystic disease. Follow-up for information regarding breast cancer development was 94% successful. Carcinoma developed more often when epithelial proliferative lesions were present. Atypical lobular hyperplasia had a greater predictive value than other epithelial lesions and was associated with an elevated risk six times that expected prior to the age of 45 years and a tripling of risk after the age of 45 years. Various ductal hyperplastic lesions are associated with approximately a doubly increased risk that is present only if the lesions are identified at biopsy after the age of 45 years. Women with cysts, sclerosing adenosis, fibrosis, and other nonhyperplastic changes were at no greater risk for subsequent carcinoma than women in the general population.

Adenofibroma↗
PubMed1977

Detergent enema: a cause of caustic colitis.

A 5-year-old boy developed acute colitis followed by stricture formation as a result of a detergent enema. The acute phase of the caustic induced colitis was reproduced in the dog and the rat using full strength and diluted detergent enemas. The severity of the experimental colitis was shown to be directly related to the concentration of the detergent.

Animals↗
PubMed1977

Bacteriological studies in a patient with antibiotic-associated pseudomembranous colitis.

Detailed aerobic and anaerobic bacteriological studies on the operative specimen from a patient with antibiotic-associated pseudomembranous colitis revealed approximately 10(11) facultatively anaerobic bacteria, but less than 10(5) obligate anaerobes per g of involved colonic tissue. Fourteen isolates of Escherichia coli, three isolates of Pseudomonas aeruginosa, and two isolates of Streptococcus fecalis were identified. The majority of the organisms were resistant to most of the antibiotics that the patient had received. Examinations of E. coli for heat-labile and heat-stable enterotoxins and tissue invasiveness were negative, and enterotoxin tests on the P. aeruginosa isolates were negative. Inoculation of mice with the bacterial isolates revealed no unusual pathogenicity. These findings suggest that antibiotic-associated colitis is associated with a marked loss in anaerobic colonic flora, but the colitis could not be explained by the presence of enterotoxins, tissue invasiveness, and pathogenicity of remaining microorganisms.

Aged↗
PubMed1977

Regional myocardial infarction of low-flow type in a neonate with tricuspid atresia.

Clinical and anatomical data are presented on a neonate with tricuspid atresia, who died at 16 hours with a regional, nontransmural myocardial infarcti after clinical documentation of akinesis. A partially occlusive intimal lesion associated with acute angulation of the right coronary artery was noted in an area of fibrosis that included the atretic tricuspid valve. Low-flow myocardial infarction was found in the posterior part of the left ventricle in an area supplied by the right coronary artery distal to the arterial lesion.

Constriction, Pathologic↗
PubMed1976

Pheochromocytoma: present diagnosis and management.

In the 25-year period 1950-1975 forty-four patients with pheochromocytoma were observed at Vanderbilt University Affiliated Hospitals. Bilateral adrenal tumors occurred in 3 patients (6.8%) and extra-adrenal tumors occurred in 7 others (16%), 33 patients (75%) had single tumors arising in one of the adrenal glands; in one of these 5 years after operation, a malignant tumor developed in the same renal fossa. Five of the 44 patients (11.3%) proved to have malignant tumors and died with metastases. In 11 patients in the earlier years of this study the clinical diagnosis was not made and the tumor was identified by the pathologist at autopsy. There was a single postoperative fatality among the 33 patients in whom the clinical diagnosis was made. Seventy per cent of all survivors with benign tumors have remained normotensive during followup periods of one to 20 years.

Adolescent↗
PubMed1976

Acute enterocolitis in a human being infected with the protozoan Cryptosporidium.

A 3-year-old child with severe acute self-limited enterocolitis was found on rectal biopsy to be infected with the protozoal parasite Cryptosporidium. This organism is known to infect a variety of vertebrates, but this is the first report of infection by Cryptosporidium in a human being. Both light and electron microscopic findings in the rectal biopsy are reported. It is suggested, on the basis of the severity of the clinical symptoms, and on the pathological changes in the rectum, that the organism in this case is likely to have been the cause of the enterocolitis and thus to have been a pathogen rather than a commensal. The source of the infection in this child could not be established. The value of signoidoscopy and biopsies is noted in this condition and as a general method for determining the etiology of a gastrointestinal infection in cases where other studies are negative.

Apicomplexa↗
PubMed1975

Ultrastructural study of amyloid material in the calcifying epithelial odontogenic tumor.

A typical calcifying epithelial odontogenic tumor of the maxilla was examined with the electron microscope. The tumor cell resembles the ameloblast at an early stage of enamel deposition. Formation of extracellular amyloid masses probably proceeds both by active cellular secretion and cell death, each process adding similar granulofibrillar material to these masses, which tend to calcify. The amyloid masses are probably a relatively homogenous protein material and represent a specific tumor cell product. Further characterization of this neoplasm must include chemical and physical studies of this extracellular tumor product, which is an amyloid material because of classic staining characteristics.

Adult↗
PubMed1975

The development of cardiac myxomas and papillary endocardial lesions from mural thrombus.

A morphologic study of 466 cardiac mural thrombi, 66 examples of nonbacterial thrombotic endocarditis, 25 myxomas, and 12 papillary endocardial lesions was performed. It appeared that three different sequences of organization of endocardial thrombi are possible. (1) Ordinary mural thrombi are converted into a flat, fibrous scar by fibroblast proliferation and collagen and elastic fiber deposition. (2) Papillary endocardial lesions develop from non bacterial thrombotic endocarditis as additional thrombus material is acquired in some foci and lost in others. No ingrowth of granulation tissue occurs at the base of these lesions. The thrombus material of the papillae is gradually replaced by fibrous tissue, and the lesion eventually is identical to a large Lambl's excrescence. (3) Myxomas enlarge in part as do the papillary endocardial lesions. In addition, their size increases as a result of influx into the myxoma of fluid from the basal granulation tissue. Although myxomas cannot be differentiated from ordinary mural thrombi on the basis of the cellular and ground substance components, their mode of development results in a distinctive appearance. The mature lesion is composed of three zones: a basal layer of small vascular channels, undifferentiated mesenchymal cells, and ground substance; a middle, acellular zone of ground substance; and a cortical layer of mesenchymal cells. The peculiar arrangement of endothelial cells and undifferentiated mesenchymal cells, the examples of apparent atrial wall invasion, and the cases of embolic "metastases" provide no conclusive evidence of neoplasia, since these features may also be seen with ordinary mural thrombi.

Aneurysm↗
PubMed1975

Carcinoma of the thyroid with description of a new scanning technic.

A statistical analysis of 193 patients with thyroid carcinoma encountered at Vanderbilt University Hospital from 1925 to 1974 is reported, from which the following conclusions are drawn: (1) Papillary thyroid carcinoma is an extremely favorable lesion that when grossly limited to one thyroid lobe can usually be managed successfully by ipsolateral total lobectomy. (2) Cervical lymph node enlargement in patients with papillary carcinoma requires lymph node dissection. When feasible, the spinal accessory nerve should be preserved. (3) Failure to cure papillary and follicular thyroid carcinoma is influenced by advanced age, inadequate local extirpation, and unresectability of the carcinoma. (4) Prophylactic lymph node dissection is rarely indicated in the treatment of follicular carcinoma. A new isotope scanning procedure, developed at Vanderbilt University Hospital, promises to be helpful in preoperatively differentiating benign from malignant solitary thyroid nodules.

Adenocarcinoma↗
PubMed1975

Surgical management of Menetrier's disease with protein-losing gastropathy.

Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric mucosa with giant rugal folds involving the fundus, cardia and body of the stomach but sparing the antrum; 2) muscosal hypertrophy consisting of gastric mjcus-secreting cells while parietal cells and chief cells are diminished in number and may be absent from many microscopic sections; 3) gastric secretion of large volume containing excess mucus, low to absent hydrochloric acid and protein concentration 5 or 6 times normal (1.7 mg/ml); 4) hypoalbuminemia and hypoglobulinemia due to loss of serum proteins fron gastric mucosa into the gastric lumen; 5) rare association with gastric ulcer. Unlike the Zollinger-Ellison syndrome none of our patients had duodenal ucler or multiple endocrine adenomatosis or a family history of these conditions. We have found no authenticated reports in the literature which document a relationship of Menetrier's disease ( as defined above) with multiple endocrine adenomatosis. Menetrier's disease with protein-losing gastropathy is a potentially lethal disorder of unknown cause with no specific treatment. Resection of the site of gastric protein losses as first done by Waugh is logical and effective. One of our three patients died in hospital before gastrectomy was done. Two others have done well for 11 months and 12 years, respectively, after total gastrectomy with Roux-en-Y esophagojejunostomy and Hunt-Lawrence jejunal pouch.

Adult↗
PubMed1975

Aortic dissection fifteen years after surgical repair of aortic coarctation.

A case of fatal dissection of the aorta fifteen years following successful surgical repair of aortic coarctation is reported. Histologic secretions of the wall of the proximal aortic segment showed significant thickening and degenerative changes in the media which were not present in the distal aortic segment. This suggests that irreversible structural changes may have occurred prior to surgical repair of the coarctation and supports the view that early surgical repair of this condition is desirable.

Adult↗
PubMed1975

Renin-secreting clear cell carcinoma of the kidney.

A young woman with mild to moderate hypertension and normal PRA, serum potassium levels, and urinary aldosterone excretion rate was found to have a renal tumor by selective renal arteriogram. Renal vein renin activity indicated an increased production of renin from the kidney containing the tumor. At surgery, a clear cell carcinoma of the kidney was found that contained renin activity in excess of the surrounding kidney tissue. The renin activity appeared identical to human kidney renin. Previous renin-producing tumors have been associated with severe hypertension, elevated plasma renin activity, hypokalemia, and elevated urinary aldosterone excretion. This case should call attention to the renin-secreting tumor as a cause of even mild hypertension.

Adenocarcinoma↗
PubMed1975

Cutaneous melanoma: a twenty-year retrospective study with clinicopathologic correlation.

The survival of melanoma patients is directly related to the involvement of regional nodes and to the microscopic level of invasion of the tumor. During the past 10 years, with the increased use of aggressive surgical therapy (wide local excision or re-excision of the primary tumor and prophylactic dissection of predictably involved regional nodes) the 5-year survival rate has more than doubled. The 5-year survival has doubled in those patients with regional lymph node involvement who were infused for 5 days with L-phenylalanine mustard. Perfusion of the lower extremities with L-phenylalanine mustard has been abandoned at Vanderbilt. The potential aggressiveness of a specific melanoma can be predicted, and thus an appropriate treatment may be planned.

Adolescent↗