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G Gephardt

Publications and source records attributed to G Gephardt.

9 recordsLinked to original sources
PubMed1999

Necessity of clinical information in surgical pathology.

OBJECTIVES: To examine the frequency and nature of problems caused by inadequate clinical data provided on surgical pathology requisition forms. DESIGN: Participants in the 1996 Q-Probes voluntary quality improvement program of the College of American Pathologists were asked to document prospectively all surgical pathology cases with inadequate information. Inadequate clinical information was defined as the pathologist's need for additional clinical information before a diagnosis could be rendered, regardless of the amount of information already present on the requisition slip. Cases that had no clinical information on a requisition slip were not counted if the lack of history did not hinder diagnosis. The study concluded when 3 months had elapsed or 40 surgical pathology cases were documented. The following data were recorded for each case: anatomic site, type of procedure, nature of disease, method of obtaining additional information, importance of obtained information, and the length of delay in the final diagnosis. PARTICIPANTS: Three hundred forty-one laboratories, 322 of which were from the United States. RESULTS: A total of 5594 cases (0.73%) required additional clinical information for diagnosis (10th through 90th percentile range, 3.01% to 0.08%). Institutions with greater average occupied bedsize, a greater number of cases accessioned per year, and a greater number of pathologists had a lower percentage of cases with inadequate clinical data (P <.05). Sixty-eight percent of these cases had no delay in completion of a case, 16.2% had a delay of 1 day or less, and 15.1% of cases were delayed more than 1 day. In 59.4% of cases, the additional clinical information obtained confirmed the initial diagnostic impression. In 25.1%, the information was not relevant to the pathologic diagnosis. In 6.1% there was a substantial change in the diagnosis or a revised report was issued, and in 2.2% no additional information could be obtained. Specific anatomic sites that correlated with a higher rate of changed diagnoses or revised reports in cases with inadequate information included the small bowel, the bronchus/lung, and the ovary. Resection specimens were also significantly associated with a higher rate of changed diagnoses or revised reports when additional information was obtained, as were malignant neoplasms and therapy-induced changes. CONCLUSIONS: This study establishes an aggregate rate of cases with inadequate clinical information for diagnosis (0.73%) and documents the extent of problems caused by inadequate clinical information. The criticality of appropriate clinical information provided to the pathologist is identified for specific anatomic sites and disease processes and is reflected in changed diagnoses or revised reports.

Humans↗
PubMed1994

Hydroxyurea-induced acute interstitial lung disease.

Hydroxyurea is a cytotoxic agent that is being increasingly used for a number of malignant and nonmalignant systemic diseases. This agent is particularly well tolerated, with dose-related myelosuppression being the primary side effect. We describe a patient who had patchy interstitial infiltrates with cavitation 2 months after the start of therapy with hydroxyurea. After hydroxyurea therapy was discontinued and empiric corticosteroid therapy was given, the pulmonary infiltrates resolved. This is a case of presumed hydroxyurea-induced lung disease, the first with supportive lung biopsy material. It is essential for physicians to be aware of this potentially life-threatening toxicity.

Acute Disease↗
PubMed1994

Anti-glomerular and anti-tubular basement membrane nephritis in a renal allograft recipient with Alport's syndrome.

A 28-year-old deaf, white man with a clinical diagnosis of Alport's syndrome since 4 years of age experienced renal failure, fever, and mental status changes suggestive of vasculitis following his first cadaveric renal transplant; these symptoms and changes resolved after removal of the allograft. Immunohistological stains demonstrated intense linear deposition of IgG and C3 in glomerular and tubular basement membranes in the absence of glomerular crescents. One year later, a second renal transplant led to similar symptoms. A biopsy was performed 14 days after engraftment, which demonstrated intense linear deposition of IgG in glomerular and tubular basement membranes, but cellular crescents were not present. A serologic profile was ordered to evaluate the patient further for vasculitis, and during the evaluation, circulating anti-glomerular basement membrane and anti-tubular basement membrane antibodies were identified by indirect immunofluorescence microscopy (titer, > 1:320). An open biopsy specimen obtained during repair of a renal laceration demonstrated a crescentic glomerulonephritis with immunohistologic findings identical to those of previous biopsies. Anti-glomerular basement membrane nephritis should be suspected in any patient with Alport's syndrome in whom progressive renal failure develops following renal transplantation. Detection of anti-glomerular basement membrane/anti-tubular basement membrane antibodies will assure the diagnosis, and early initiation of plasmapheresis may be helpful to prevent further renal damage.

Adult↗
PubMed1991

Long-term follow-up after partial removal of a solitary kidney.

BACKGROUND: The removal of more than one kidney in animals leads to proteinuria and progressive renal failure due to focal segmental glomerulosclerosis. This injury may be the result of chronic glomerular hyperfiltration. The purpose of this study was to determine the effect of a reduction in renal mass of more than 50 percent on residual renal function and morphology in humans. METHODS: We evaluated long-term renal function in 14 patients with a solitary kidney who had undergone partial nephrectomy for renal-cell or transitional-cell carcinoma. In 12, the first kidney had been removed 2 months to 21 years previously for the same type of cancer; in 2, the other kidney was congenitally atrophic. Before surgery, no patient had clinical or histopathological evidence of primary renal disease. All 14 patients underwent partial nephrectomy to remove a localized tumor, with 25 to 75 percent of the solitary kidney being excised. They were evaluated 5 to 17 years after surgery (mean, 7.7). RESULTS: Twelve patients had stable postoperative renal function, and end-stage renal failure developed in two. There were no changes in blood pressure in any patient during follow-up. Nine patients had proteinuria, which was mild (0.15 to 0.8 g of urinary protein per day) in five. The extent of proteinuria was inversely correlated with the amount of remaining renal tissue (P = 0.0065) and directly correlated with the duration of follow-up (P = 0.0005). Four patients with moderate-to-severe proteinuria had renal biopsies, which revealed focal segmental glomerulosclerosis in three patients and global glomerulosclerosis in one. CONCLUSIONS: Long-term renal function remains stable in most patients with a reduction in renal mass of more than 50 percent. These patients are, however, at increased risk for proteinuria, glomerulopathy, and progressive renal failure.

Adult↗
PubMed1991

The growing teratoma syndrome.

A 26-year-old man presented with multiple pulmonary nodules and a left testicular mass. Combination chemotherapy for a malignant, mixed germ cell testicular tumor resulted in shrinkage of the pulmonary nodules and normalization of the tumor markers (beta-HCG, LDH and AFP). Subsequent surgical excision performed for enlargement of the pulmonary nodules revealed mature teratomas, diagnostic of the GTS.

Adult↗
PubMed1980

An approach to immunomicroscopy of renal disease with immunoperoxidase and periodic acid-Schiff counterstain (IMPAS stain).

A series of 127 renal specimens reflecting a wide spectrum of renal pathology was evaluated with a direct immunoperoxidase technic in which frozen tissue was first reacted with anti-Ig(G,A,M) and anti-C3-peroxidase conjugates and subsequently counterstained with periodic acid-Schiff-hematoxylin (IMPAS). This technic permitted simultaneous evaluation of light-microscopic changes and yielded a permanent immunomicroscopic record. Frequently, a distinction could be made between epimembranous, intramembranous and subendothelial deposits, which was not possible using immunofluorescence. The findings were correlated with histologic, immunofluorescent and electron-microscopic results. General patterns of immune complex and autoantibody deposition were similar in 124 cases. In one case, there was poor correlation between results obtained by immunoperoxidase and immunofluorescence. In two other cases, deposits detected by electron microscopy were not identified by either immunoperoxidase or immunofluorescence. The IMPAS stain, combining immunomicroscopy with conventional light microscopy, may be a useful approach to the laboratory diagnosis of renal disease.

Antigen-Antibody Complex↗
PubMed1975

Radiographic manifestations of malignant mixed uterine tumors.

Malignant mixed uterine tumors have a varied radiographic appearance. The primary tumor is usually evident as an enlarged uterus, frequently with localized, faint, punctate calcification. New or increasing calcification within an enlarging uterus of a postmenopausal female should raise the suspicion of mixed malignant uterine tumor. Metastases are common, and usually involve the lung, most often becoming apparent quite rapidly. The pattern of pulmonary metastases is varied from large masses to lymphangitic spread, hilar lymph nodes and pleural effusions being common. Calcification within pulmonary secondaries may occur and cavitation has been observed.

Aged↗
PubMedDate not supplied

Urticaria, nephritis, and pseudotumor cerebri.

The spectrum of chronic urticarial disease ranges from chronic urticarial skin lesions alone to well-characterized systemic lupus erythematosus with urticarial vasculitis as the major skin manifestation. Within this spectrum is the syndrome of urticarial vasculitis associated with systemic disease manifestations. There have been six previously recorded cases of urticarial vasculitis associated with pseudotumor cerebri. At least two of these have included membranoproliferative glomerulonephritis. The authors report a case of chronic urticarial disease associated with pseudotumor cerebri and membranoproliferative glomerulonephritis, but without demonstrable vasculitis. It is possible that this represents a distinct entity within the spectrum of chronic urticarial disease and cca be easily screened for in clinical practice.

Acetazolamide↗