Biomedical subjects
Publications and source records attributed to F Abreo.
The differential diagnosis for a 69-year-old man with pulmonary nodules and glomerulonephritis is discussed in the setting of a Clinicopathological Conference at Louisiana State University Medical Center in Shreveport, Louisiana. The pathophysiology and etiology of pulmonary-renal syndromes are discussed.
BACKGROUND: To determine the reliability of repeat cervical smears (Papanicolaou smears) in patients who have had an abnormal initial smear, prospective data were collected on patients being followed up for a previously abnormal cervical smear. METHODS: All 428 patients who were referred for colposcopy because of abnormal cervical smears underwent simultaneous cervical smears and coloposcopy with directed biopsy. Patients with colposcopic evidence of invasive carcinoma or a history of prior colposcopy were excluded. Cervical smear results were compared with the histologic findings on colposcopically directed biopsy. The ability of cervical smears to identify cervical intraepithelial neoplasia (CIN) and high-grade lesions (CIN 2 and 3) were also calculated for the repeat cervical smear. RESULTS: The sensitivity of repeat Papanicolau screening for CIN was 48%. When differentiating high-grade lesions from low-grade and benign biopsies, the sensitivity of the repeat cervical smear was only 25%. Of 110 patients with biopsy-proven high-grade lesions, 68% had low-grade initial cervical smears and 73% had low-grade or benign repeat cervical smear cytology. CONCLUSIONS: This study demonstrates that repeated Pap smears often fail to identify high-grade lesions and that the sensitivity of a repeat cervical smear is very low in patients with low-grade abnormalities found on routine screening examinations. Using follow-up cervical smears to monitor patients who have low-grade squamous intraepithelial lesions (LGSIL) carries unacceptable risks. A more reliable diagnostic test such as colposcopy is indicated.
The differential diagnosis for a 38-year-old white man with a chronic fever associated with nephrotic syndrome is discussed in the setting of a clinicopathological conference at Louisiana State University Medical Center in Shreveport, Louisiana. The etiology and pathophysiology of fever-associated nephrotic syndrome are discussed.
The differential diagnosis for a 57-year-old man with joint pain, bruising, and diarrhea is discussed in the setting of a Clinical Pathological Conference at Louisiana State University Medical Center in Shreveport, La. The pathophysiology and etiology of malabsorptive states are presented.
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OBJECTIVE: To describe a case of autoimmune exocrinopathy in a child at the age of 3 months who presented with the original diagnosis of recurrent parotitis. DESIGN: This a case report of a 9-year-old girl with recurrent parotitis who was later found to have Sjögren's syndrome. The literature relating to primary Sjögren's syndrome in the pediatric population is reviewed. SETTING: The patient was seen in the rheumatology and otolaryngology clinics at a university medical center. INTERVENTIONS: This study did not address therapy. MAIN OUTCOME MEASURE: Diagnosis of Sjögren's syndrome. RESULTS: The patient had xerostomia, an abnormal result of a salivary gland biopsy, SSA and SSB antibodies, and the histocompatibility antigens HLA-B8 and HLA-DR3 that are associated with Sjögren's syndrome. CONCLUSION: Primary Sjögren's syndrome should be considered in cases of recurrent parotitis of childhood. More studies are needed to assess the natural history of autoimmune exocrinopathy in children.
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Sixteen patients with spinal epidural compression by metastatic small-cell lung cancer were given radiotherapy for palliation. Lower limb motor deficit was the most prominent clinical manifestation. Neurologic dysfunction was commonly present for more than 48 hours before the diagnosis of compression. Median interval between diagnosis of lung cancer and epidural tumor was 8.5 months. Twelve percent of the patients survived for 1 year after diagnosis of epidural compression. Radiotherapy gave significant pain relief to eight (89%) of the symptomatic individuals. Among those whose status could be assessed, one third of the initially nonambulatory patients (n = 9) were able to walk again. Anal or bladder sphincter or sensory disturbance did not improve in four persons. Radiotherapy for spinal epidural compression in small-cell lung cancer, though not curative, is highly effective in the relief of pain and may ameliorate limb motor dysfunction in some patients.
Only five cases of osteomyelitis of the mandible as a result of sickle disease have been published. We report another case, which uniquely affected not only the osseous portion of the mandible, including the condyle, but also the adjacent musculature. Radical resection of the involved hard and soft tissue was necessary to cure the patient. Two possible etiologies are discussed. The first states that the sickle cell crisis caused a tissue anoxia in which this tissue became secondarily infected; the second states that the preexisting infection triggered or augmented the sickling phenomena.
Basal cell carcinoma is rare in blacks. A clinical and histopathologic review of 43 basal cell carcinomas in 26 black patients is reported. Basal cell carcinoma was found to be more common in women than in men. Our data indicated a lower prevalence on the nose and trunk compared with other reports. Multiple tumors were more common in our series. Our study included the youngest black patient with a pure basal cell carcinoma, the first reported superficial basal cell carcinoma, the second reported perianal basal cell carcinoma, and one albino patient with 12 tumors. Histologically there was a positive correlation between the maximum depth of tumor invasion and the maximum diameter of the lesion. Of three basal cell carcinomas arising in scars, metastasis developed in one. Our report includes a review of basal cell carcinomas in North American blacks.
This retrospective study examined the outcome in 42 women with early stage (FIGO I/II) endometrial adenocarcinoma (papillary, n = 22 and nonpapillary, n = 20). In patients with papillary carcinoma, median survival was longer when surgery and/or radiotherapy was applied (18 to 36 months) than when such treatment was not used or systemic progestational therapy was employed (6 to 9 months). Among those evaluable women, the 5-year survival rate was significantly (p = 0.01) better in the nonpapillary than the papillary type adenocarcinoma, 45% (9/20) versus 6% (1/16) respectively. However, abdominal failure and distant metastasis rates in papillary carcinoma were 5% while local recurrence and distant metastasis rates in the nonpapillary variety were correspondingly 20% and 15%.
This retrospective study involved 55 patients, 35 years old or less with invasive carcinoma of the cervix. There were 49 squamous carcinomas, 3 adenocarcinomas, and 3 unusual varieties. Thirty-five patients had stage IB disease; 4 had stage IIA disease; 6 had stage IIB disease; 5 had stage IIIB disease, and 3 had stage IV disease. Treatments employed were either radical hysterectomy and node dissection, irradiation, or irradiation followed by radical surgery. Our overall 5-year disease-free survival among young females with stage IB disease was observed to be only 43%; stage IIA only 25%; stage IIB only 17%, and no survivors in more advanced stages.
A patient with umbilical metastasis from a primary squamous carcinoma of the cervix is presented and the literature is reviewed.
The purpose of this study was to evaluate the efficacy and safety of a recently developed transluminal lysing system in the removal of coronary stenotic lesions from a human cadaver heart and in the cannulation of coronaries in the anesthetized dog. The left coronary arteries of three dogs were cannulated on separate occasions, with coronary arteriography and translation of the transluminal lysing system cutter to the distal segments of the coronary vessels performed each time. Proximal and distal coronary pressures were recorded from the guiding catheter and the transluminal lysing system cutter, demonstrating no significant pressure differential and minimal damping. Pathological examination of the dog coronaries after sacrifice demonstrated minor intimal irregularities with no significant thrombosis or vessel perforation. A significant portion of the occlusive stenotic lesions were removed from coronary vessels of a human cadaver heart with subsequent reestablishment of angiographic dye flow to the distal coronary vessels without evidence of debris loss from the transluminal lysing system cutter or the appearance of occlusions in the distal vessels. We conclude that the transluminal lysing system can be introduced into the coronary artery of a living dog on repeated occasions without causing significant coronary damage, coronary occlusive thrombosis, myocardial destruction, morbidity, or mortality; furthermore, occlusive stenotic lesions can be removed from cadaver coronary vessels by the transluminal lysing system with the establishment of angiography patency.
A case of idiopathic crescentic membranous glomerulonephritis is reported. In addition to the present case, eight cases of this type of glomerulonephritis reported in the literature are reviewed. This is an uncommon form of glomerulonephritis, seen in middle age and in both sexes. Clinical presentation is similar to idiopathic membranous nephropathy. Lupus and antiglomerular-basement membrane nephritis should be excluded by serological tests. Prognosis is grave, resulting in end-stage renal failure (ESRD) within a year in most patients. There is no specific therapy known to alter the course of the disease. In this patient, short courses of high-dose corticosteroids, administered during flares of glomerulonephritis, seemed to improve renal function.
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OBJECTIVE: To evaluate histologic findings in patients aged 50 and older whose cervical smears revealed atypical glandular cells of undetermined significance (AGUS). STUDY DESIGN: Computerized records spanning a four-year period were retrospectively analyzed. Thirty patients over age 50 had cervical smears interpreted as AGUS and had follow-up biopsies within 12 months following the abnormal smear. The most important histologic diagnosis from the biopsy specimens was correlated with the subcategory of the cervical smear. RESULTS: Five smears interpreted as AGUS, favor reactive, revealed abnormal histology in four cases: three endometrial polyps and one squamous carcinoma. Two smears interpreted as AGUS, favor dysplasia, revealed squamous intraepithelial lesions on biopsy in both cases. Seventeen smears interpreted as AGUS, favor endometrial cells, revealed abnormal histology in 13 cases: 1 endocervical polyp, 6 endometrial polyps, 3 endometrial hyperplasias and 3 adenomyosis. Six patients with smears interpreted as AGUS, unclassifiable, revealed abnormal histology in five cases: two endocervical polyps, one endometrial polyp, one endometrial carcinoma and one ovarian carcinoma. CONCLUSION: The presence of AGUS in cervical smears from women over 50 was highly predictive of abnormal lesions detected by histologic examination. Although three cancers were detected on histologic follow-up, the most common lesions detected were endometrial polyps.
A resurgence of measles, a highly infectious viral infection, has occurred in the United States. In this report the sputum cytology from a case of measles pneumonia is described and discussed. Only a few recent reports have described the cytopathologic changes of measles. Familiarity with the typical cytologic changes of measles will assist in the diagnosis of this infection.