Biomedical subjects
Publications and source records attributed to G Leiman.
A previously unreported high incidence of endoscopically identifiable, diffuse, largely nonulcerative esophagitis, is described in a selected population of Southern African blacks at risk of cancer of the esophagus. This is comparable with findings in similar groups in Iran and China. The incidence of dysplasia and "early" cancer is still undefined in South Africa.
Sequential tracheal aspirates from 39 neonates with hyaline membrane disease were examined to correlate cytological findings with the development of bronchopulmonary dysplasia (BPD). A total of 224 tracheal aspirates were examined from these infants, 15 of whom developed BPD as diagnosed by conventional clinical and radiological criteria. Hyperplastic and metaplastic epithelial changes were observed in all infants studied. Dysplastic changes occurred in 14 of 15 who developed BPD, and 14 of 24 who had a normal outcome (P less than 0.02). The exfoliation of dysplastic metaplastic bronchial cells was thus 95% specific and 71% sensitive for the subsequent development of BPD. Factors associated with the development of BPD were very low birth weight and gestational age, persistence of a patent ductus arteriosus, high peak inspiratory pressure (cm of H2O/kg), prolonged assisted ventilation, and rapidity of development of class III (dysplastic) changes in tracheal aspirates.
The first recorded case of renal adenocarcinoma presenting with bilateral metastases to the Bartholin's glands is presented. Primary diagnosis of the metastatic deposits was made by fine-needle aspiration cytology with subsequent localization of the unsuspected renal primary. The value of fine-needle aspiration in the identification of inapparent primary tumors is discussed and cytological findings are described in detail.
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A simple, easily constructed, and inexpensive suction-abrasive cytology tube was developed to study esophageal cytology. The reliability of this method for the diagnosis of esophageal carcinoma was evaluated in 101 patients. Of 47 patients with esophageal carcinoma, 93% were diagnosed correctly on exfoliative cytology. There were no false diagnoses of cancer. The cytology tube was well tolerated by all patients and provided a rapid and reliable method of diagnosis. As a screening procedure, this method may be applicable for widespread use to detect early esophageal cancer in high-risk populations.
The clinical details of a case of squamous carcinoma of the cervix in a 15-year-old girl are described. Factors relating to age, virginity and aetiology in this, possibly the youngest case ever reported, are discussed.
The finding of adenosis in the vaginal pouch of a patient with agenesis of th lower Müllerian tract suggests that not all cases of vaginal adenosis are Müllerian in origin.
Eighty-five samples of pleural fluid obtained from 76 patients with biopsy-proven tuberculous pleurisy were examined cytologically. Numerous reactive mesothelial cells were present in only 1,2% of specimens examined. In contrast, 65,3% of pleural fluid aspirates obtained from a control group of patients in congestive cardiac failure contained marked mesothelial exfoliation. The suggestion that the presence of numerous, often highly reactive mesothelial cells in a pleural aspirate makes the diagnosis of tuberculosis unlikely is confirmed.
A prospective trial of the efficacy of cryotherapy in cervical intra-epithelial neoplasia (CIN) was initiated at Baragwanath Hospital in Soweto, and incorporated 200 Black patients who had been evaluated by colposcopy and directed cervical biopsy before inclusion in the study. Only 52 patients (26%) achieved cytonegativity and adhered to the continuing follow-up schedule as advised (12 of these patients required repeat cryotherapy to achieve a cure). Another 39 patients (19,5%) were cytonegative when last seen, but did not fulfil the follow-up criteria required. Inclusive of this latter group, the cure rate achieved was 45,5% of the entire series, the average follow-up period being only 7,08 months. The results of the study demonstrated that cryotherapy cannot be regarded as the ideal form of management of CIN in a newly screened population, in whom the lesions detected are often extensive, with deep intraglandular involvement, and extension into the endocervical canal. For maximal therapeutic efficacy in any new cancer screening programme, it is advised that a policy of more liberal recourse to cold-knife conization be adopted, cryotherapy being reserved for patients with lesser degrees of CIN, in whom the lesion is confined to the surface epithelium of the ectocervix only
A retrospective study of 88 pregnancies occurring in 77 patients after cervical conization was undertaken to compare pregnancy outcome with cone size. Cone specimens were divided into two groups. Those measuring less than 2 cm in height or less than 4 cc in volume were considered to be "small cones" and those greater than 2 cm in height or 4 cc in volume were regarded as "large cones." The over-all normal term vaginal delivery rate was 46.6%, and was found to be inversely proportional to the size of the cone. The incidence of both spontaneous midtrimester abortion and prematurity increased in direct proportion to cone size. Cervical stenosis necessitating cesarean section was, however, noted to be a complication associated with small rather than large cones. It was concluded from this study that all postcone pregnancies should be regarded as high risk, preterm complications being particularly related to large cones.
A prospective consecutive series of 210 upper gastrointestinal endoscopic procedures, at which material for both cytological and histopathological examination was obtained, was conducted at Baragwanath Hospital. The purpose of the study was to determine the respective and combined diagnostic value of endoscopic visualization, cytological brushings and histological sections in benign and malignant lesions of the oesophagus and stomach; and in particular to assess the contribution, if any, of exfoliative cytology to the diagnostic regimen. Endoscopic visualization alone was inconclusive or incorrect in 13% of procedures, cytology alone in 9%, and biopsy alone in 12% (the latter 2 figures corrected for adequacy of material submitted). When assessed together, the diagnostic accuracy achieved by all 3 techniques was 99%. The major contribution of cytology was the correct positive diagnosis in 20% of procedures, performed on patients with malignant lesions, whose initial biopsy specimen was inadequate or normal. It is concluded that for maximal diagnostic accuracy of upper gastro-intestinal lesions, a combined approach, utilizing endoscopic examination, lesion-directed brushings and biopsy specimens, is required.
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A patient with adenosquamous carcinoma of the uterine cervix, who presented with partial intestinal obstruction and a macroscopically normal cervix, is reported. The literature is reviewed.
The results of cervical smears done on the first 15 000 women screened by the cytology laboratory established in the Johannesburg clinic of the Transvaal Family Planning Association in July 1972, are recorded. Analysis indicates a high cytological detection rate of severe dysplasia and carcinoma in situ (20,2 per 1 000), and of microinvasion and frank invasion (1,8 per 1 000). The total positive pick-up rate was thus 22 per 1 000 women screened. Many potentially progressive atypias and mild-to-moderate dysplasias requiring cytological follow-up have also been disclosed. An analysis of the race, age and parity profiles of women in the positive group is recorded, and details of treatment and subsequent follow-up are noted. The results of this programme are compared with other published studies. It would appear that a family planning clinic population is an ideal target for anticipated mass screening programmes in this country.
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The clinicopathologic features of a case of scar endometriosis are presented. The lesion is unusual in that it occurred in a black woman following tubal surgery for ectopic pregnancy. The case appears to be unique in that the endometriotic focus was characterized by the presence of mucinous metaplasia. Diagnosis of this histopathologic curiosity was made by fine needle aspiration cytology.
The cytologic diagnosis by intraoperative fine-needle aspiration of a case of partially cystic adenosquamous carcinoma of the pancreas is reported. Tissue for histologic confirmation was not obtained. Confirmatory ultrastructural and immunochemical findings are thus presented.