Biomedical subjects
Publications and source records attributed to F Salem.
A 71 year-old woman with a large tumor of the upper lobe of the left lung was diagnosed as having metastatic adrenal cortical carcinoma nine years after the initial adrenalo-nephrectomy. The patient was well with no recurrence for six years following resection of the single lung metastasis.
UNLABELLED: The approach to the diagnosis and management of patients with diffuse infiltrative lung disease (DILD) is controversial. The results of transbronchial biopsy are often unsatisfactory. The role of open lung biopsy is highly variable. Percutaneous cutting needle biopsy (CNB) is not recommended because of its reported high morbidity/mortality relative to its low diagnostic yield. We report a technique for CNB with a high diagnostic yield and a low morbidity and no mortality in 228 patients with DILD over the past 23 years. METHODS: The salient features of the technique for CNB are as follows: the anesthetic needle does not enter the pleural space; a Franklin Silverman needle is inserted into the intercostal space posteriorly at outer one-third of chest wall; the biopsy is performed with the breath held at normal end expiration; the plane of pleural space is broken with sudden insertion of needle 8 to 15 cm into lung; and the pathway of the needle is maintained parallel to the lateral chest wall. RESULTS: A diagnosis was established in 129 of 145 biopsies (89%) performed by a trained operator (A.H.N.). There were 36 pneumothoraces (25%), four minimal hemoptyses (3%), and two chest tube placements (1%). There were no deaths (0%). CONCLUSION: With meticulous attention to technique and careful selection of patients, the procedure offers a relatively safe alternative to open lung or thoracoscopic lung biopsy in patients with DILD.
We report four sibs from a consanguineous Arab Bedouin family with short stature, mental retardation, a peculiar face, a short webbed neck, skin changes and congenital heart defects. We suggest that the constellation of abnormalities in these children could represent a newly recognized syndrome.
The first atypical Papanicolaou smear in young, sexually active Latino and African-American women of low socioeconomic status may be predictive of underlying cervical neoplasia and human papillomavirus infection of significant quantity. The optimal management of first-time atypia on routine Pap smear has not been established. In many clinics, colposcopically directed sampling of the cervix is recommended only if atypia persists following specific or nonspecific treatment of cervicitis or after an arbitrarily determined time interval. Others recommend immediate colposcopic evaluation. To determine the best approach to the first-time atypical Pap smear in young minority women at high risk for the development of cervical cancer, 250 such patients were evaluated with colposcopically directed biopsy of the cervix prior to any form of therapy. Pap smears were repeated at the time of colposcopy. Histologically, there was evidence of cervical intraepithelial neoplasia in 41% of patients and human papillomavirus infection in 86%. Repeat Pap smears predicted the presence of cervical intraepithelial neoplasia in only 24% of patients. Immediate colposcopic evaluation represents the most prudent approach to the first-time atypical Pap smear in young, high-risk minority women.
In surgery of the acute dissection of the ascending aorta, a technique is described for routine cannulation through a Dacron graft in order to produce antegrade flow in the true aortic lumen and higher pressures than in the false lumen. This is a useful method to avoid the deleterious effects of the retrograde blood flow through the false lumen, when femoral cannulation is used, as well as to improve the myocardial protection by reperfusing the myocardium while the graft distal end anastomosis is carried out.
A case report of a man with a huge, left-sided diaphragmatic rhabdomyosarcoma is presented. The mass was attached to the lung, pericardium, left phrenic nerve, sternum, and chest wall. Enbloc resection of the tumor was done with primary repair of the diaphragmatic defect. Only three reported cases of primary diaphragmatic rhabdomyosarcoma were found in the literature.
Eighty-nine random Pap smears of the uterine cervix were examined to evaluate the phagocytic abnormal cells (PACs) of atypical, dysplastic and neoplastic tissues against infiltrated blood cells. The results revealed that none of the PACs have been identified in atypical (II) and mild dysplastic cells (IIIa). Low levels (1.2%) of PACs were initially demonstrated in patients with moderate dysplasia (IIIb) that increased 1.7-fold in subsequent severe dysplasia (IIIc) and further increased 2.8-fold in invasive carcinomas of the cervix (V). In addition, the data showed age-related responsiveness toward the development of PACs, where 82% of old patients have developed phagocytic activity in moderate dysplastic cells compared with 27% of young patients. However, the difference became less significant at the subsequent classes of the disease. These data further demonstrated that PACs are class-dependent and it may explain one mechanism by which precancerous cells escape immunosurveillance.
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Lymphophagocytosis by nonlymphoreticular neoplasms has been observed. Twenty cancer patients having either adenocarcinoma or epidermoid carcinoma were the subjects of our study. Malignant cells were found to phagocytize autologous lymphocytes, polymorphonuclear cells (PMNs) and red blood cells (RBCs). Papanicolaou smears from cancer patients revealed that 30% (6/20) of the patients had phagocytic malignant cells in situ, the mean phagocytosis for this group was 3.7%. Different cellular elements showed differences in their susceptibility towards phagocytic activity of tumor cells: 2.6% for lymphocytes, 0.7% for PMNs and 0.4% for RBCs. The patients having phagocytic malignant cells showed complete absence of monocytes in their peripheral blood. In contrast, other patients had peripheral blood monocyte percentages within the limits of control values (7.2). However, there was no correlation between development of phagocytic activity of malignant cells and age and sex of patients or type of tumor. This study further confirms that phagocytic activity of nonlymphoreticular neoplasms is a general phenomenon which can be directed against erythroid elements. In addition, we have demonstrated that these tumor cells also phagocytize autologous leukocytes.
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Tuberculosis is one of the world's most important communicable diseases. Although it may involve the genital tract and frequently results in infertility, the presentation of the disease as a pelvic mass is uncommon. While the incidence of tuberculosis has declined in the United States, genital tuberculosis should be considered in patients presenting with adnexal mass and a history of infertility. One such case is presented here, and diagnosis and treatment are described.
A case of acute and spontaneous spinal epidural hemorrhage is described in which there was no history or evidence of trauma, conventional anticoagulant therapy, hemophilia or vascular anomalies. A recent history of excessive ingestion of an aspirin-containing medication was obtained and the clinical and laboratory picture of an aspirin-induced bleeding disorder was documented. We have discussed the mechanism and hematological considerations of the syndrome of aspirin induced bleeding.