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H A Oberman

Publications and source records attributed to H A Oberman.

At least 19 recordsLinked to original sources
PubMed1992

Can the reading for serologic reactivity following 37 degrees C incubation be omitted?

The need to detect antibodies that agglutinate and/or hemolyze red cells (RBCs) directly at 37 degrees C, but do not react in subsequently performed indirect antiglobulin tests (IATs), is of concern relative to the streamlining and automation of antibody detection methods. To determine incidence and significance of such reactions, data from 87,480 tests, which used low-ionic-strength saline, 10-minute incubation at 37 degrees C, and anti-IgG, were analyzed for unexpected antibodies. There were 3590 positive tests, of which 475 showed reactions at 37 degrees C but not in subsequently performed IATs (37 + IAT-). Of these, 196 reactions were due to autoantibodies or other factors usually considered insignificant with respect to the survival of transfused incompatible RBCs, 176 were due to alloantibodies of questionable clinical significance (M, Lea, P1, etc.), and 103 were associated with alloantibodies of potential clinical significance (63 E, 27 K, 5 Jka, 4 D, 3 cE, and 1 C). This latter reaction was seen in 72 patients, with two 37 + IAT-antibodies occurring in each of 3 patients. Of the 75 potentially significant 37 + IAT-antibodies, 57 were seen in patients recently exposed to homologous RBCs, 13 in patients with a history of transfusion and/or pregnancy, and 5 in patients with no known exposure to homologous RBCs. IAT reactivity was observed in subsequent samples with 27 of these antibodies. The predictive value of a 37 + IAT-test was 21.7 percent for a potentially significant antibody. The incidence was 0.12 percent of all tests for unexpected antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Group Antigens↗
PubMed1991

Noninvasive carcinoma of the breast presenting in adenosis.

Although sclerosing adenosis is a common abnormality in the female breast, malignant change presenting in this setting is exceedingly rare, as fewer than 20 cases have been reported. Since sclerosing adenosis is a lesion of the mammary lobule, it is not surprising that the majority of reported cases have been lobular carcinoma in situ (LCIS). Nine patients with noninvasive carcinoma, restricted in the initial biopsy specimen to foci of sclerosing adenosis, are reported. Seven of the patients had LCIS, one had intraductal carcinoma (DCIS), and one had both LCIS and DCIS. In six of the nine patients, the carcinoma was an incidental finding in a breast biopsy performed for fibrocystic changes or for a fibroadenoma, and in three patients, the abnormality presented as a grossly discrete lesion due to confluence of foci of adenosis (tumoral adenosis). It is important to recognize this microscopic pattern of neoplasia to prevent its misdiagnosis as invasive carcinoma. Two patients had no further treatment following initial excisional biopsy. No residual carcinoma was found in the breast or in lymph nodes in the four patients who had mastectomy. Eight of these patients have been followed for an average of 3 yr (range, 2 to 7 yr), and all are alive and well, without recurrence. Because of the possibility of multifocality, the rarity of the lesion, and the relatively brief follow-up interval, it seems prudent to treat these patients in a manner comparable to that of patients with more common presentations of noninvasive carcinoma.

Adult↗
PubMed1990

Percutaneous umbilical blood sampling and umbilical vein transfusions. Rapid serologic differentiation of fetal blood from maternal blood.

Percutaneous umbilical blood samples (PUBS), obtained under ultrasound guidance, are used for prenatal diagnosis and management of hemolytic disease of the newborn (HDN) and other fetal disorders. Rapid testing at the time of sampling is vital to distinguish fetal from maternal blood. Blood typing was performed by slide technique in the treatment room during 38 procedures on 25 patients. Anti-I was used to test 50 presumed PUBS; venous I-positive maternal blood was tested in parallel. Because anti-I cannot detect fetal blood after umbilical vein transfusion (UVT) of I-positive donor blood, ABO and Rh blood typing reagents were used to test 29 samples when maternal and fetal or donor blood groups differed. Monoclonal reagents were used for optimal detection of weak AB antigens in fetal blood. Avid, chemically modified anti-D was used for Rh typing. Blood typing showed 27 (34%) of 79 samples to be maternal blood. Fetal blood was obtained in 8 of 10 cases investigated for fetal disorder and in 16 cases of potential HDN (anti-D, 5; -CD, 5; -cE, 2; -K, 2; -c; -E). The absence of HDN (antigen-negative fetus) was determined in 4 cases. UVT afforded live birth of 9 of 10 infants with HDN and was not indicated in two cases.

Blood Grouping and Crossmatching↗
PubMed1990

Blood use during extracorporeal membrane oxygenation.

An analysis of the transfusion records of 91 neonatal patients subjected to extracorporeal membrane oxygenation (ECMO) is reported. Mean daily blood usage was 250 mL of red cells (RBCs), 80 mL of fresh-frozen plasma, and 2 units of platelets. Average time on ECMO was 4.6 days. Group O or ABO type-specific RBCs and group AB or ABO type-specific plasma products and platelets were transfused. RBCs were not washed, and neither RBCs nor other components were tested for anticytomegalovirus (CMV) or irradiated. No cases of posttransfusion CMV infection or graft-versus-host disease were observed. Hemolysis in eight patients was traced to occlusions in the ECMO circuit. All but three patients survived ECMO. Contrary to a previous report, an active ECMO program for neonatal patients imposes a minimal burden on the hospital transfusion service.

Bilirubin↗
PubMed1990

Radial sclerosing lesion of the breast: mammographic features.

The authors present the clinical, mammographic, and pathologic findings in seven patients with radial sclerosing lesions (RSLs) who had a nonpalpable stellate lesion at mammography. Although the radiographic findings were suggestive of RSL in six of seven patients, diagnostic excisional biopsy was recommended for all. One RSL had associated microcalcifications localized in contiguous adenosis. The authors did not find this a useful criterion to differentiate RSL from carcinoma. Similarly, the presence of either a lucent or dense central core was not radiographically diagnostic. Surgical excision of these stellate lesions is therefore required.

Breast↗
PubMed1989

Breast hamartomas: variable mammographic appearance.

The mammograms of 17 women with pathologically proved breast hamartomas were reviewed. Abnormal masses were detected on 12. Nine women had masses with benign features. Two of these had findings considered classic for hamartoma. In three cases, the appearance of the mass was suggestive of carcinoma. The breasts were very dense in four of five women without detectable mass. The findings suggest that the classic mammographic appearance of breast hamartomas is less common than previously reported, which may be explained by earlier detection of small hamartomas.

Adult↗
PubMed1989

Paraffin tissue block radiography: adjunct to breast specimen radiography.

Radiography of specimens is an essential step in confirming excision of nonpalpable breast lesions. On occasion, however, the pathologist may not identify the lesion histologically. The authors report five cases in which suspicious microcalcifications were included in the excised tissue but were not identified by the pathologist. In all five, paraffin tissue block radiography enabled identification of the specific blocks containing the microcalcifications. The correct tissue blocks were then sectioned again, and the microcalcifications were identified histopathologically. In one case, the initial diagnosis of intraductal hyperplasia was changed to intraductal carcinoma with focal invasion. When the pathologist cannot identify the calcifications on initial histopathologic sections, this technique may assist in identification of the mammographic abnormality.

Biopsy↗
PubMed1987

Invasive carcinoma of the breast with granulomatous response.

Three patients are described who had invasive ductal carcinoma associated with noncaseating epithelioid granulomas. Multinucleated giant cells, predominantly of Langhans' type, were present in the granulomas. The granulomas were restricted to the carcinoma, and no granulomatous response was evident in regional lymph nodes. None of the patients had clinical evidence of systemic granulomatous disease, although one patient subsequently was found to have hepatic portal granulomas. This uncommon tissue response to neoplasm is distinct from carcinomas with osteoclast-like multinucleated giant cells. Similarly, the process differs from the granulomas presenting in axillary lymph nodes that drain a carcinoma.

Aged↗
PubMed1987

Metaplastic carcinoma of the breast. A clinicopathologic study of 29 patients.

The clinical and pathologic findings in 29 patients whose primary breast neoplasm manifested the microscopic pattern of spindle cell carcinoma or extensive squamous or pseudosarcomatous metaplasia were studied. In several of the tumors, the diagnosis of primary sarcoma or squamous cell carcinoma was excluded only after a prolonged search for evidence of invasive ductal carcinoma. The paucity of axillary lymph node metastases and the circumscription of these neoplasms belied their aggressive clinical behavior. The size of the neoplasm at the time of initial treatment best correlated with prognosis, since the majority of patients whose carcinoma was less than 4 cm in diameter pursued a favorable course. The lack of correlation of the microscopic pattern of these neoplasms with prognosis, as well as the presence of apparent overlapping microscopic findings, supports the concept that they are variants of a single entity.

Adult↗
PubMed1985

Juvenile (cellular) adenofibromas. A clinicopathologic study.

"Juvenile" adenofibromas that presented in 25 patients were reviewed. All of the patients were in the second decade of life. The tumors were solitary in 19 patients and multiple and bilateral in six patients. All were distinguished microscopically by prominent cellularity of both epithelium and stroma. Patients who presented with solitary tumors, regardless of size, microscopic pattern, or manner of excision, had no recurrence. In contrast, all patients who presented with multiple tumors developed additional benign masses, often requiring re-excision. We believe that solitary "juvenile adenofibromas," regardless of size, should be excised so as to preserve as much breast tissue as possible. Those patients with multiple, bilateral tumors may anticipate recurrences, but malignant change is not seen. Tumors with this microscopic pattern also may occur, albeit uncommonly, in adults.

Adenofibroma↗
PubMed1979

Tubular carcinoma of the breast.

Twenty-five patients with tubular carcinoma of the breast were reviewed. All of the lesions were small, averaging 0.9 cm in diameter, and none exceeded 2.0 cm in diameter. Regardless of treatment, the prognosis proved favorable. Only three of the patients manifested axillary lymph nodal metastases, and none died of recurrent or metastatic neoplasm. These neoplasms frequently were associated with intraductal carcinoma and, to a lesser extent, with lobular carcinoma in situ. It is concluded that tubular carcinoma represents a slow-growing expression of invasive mammary carcinoma; nevertheless, it is likely that, if inadequately treated, these lesions will evolve into more common patterns of invasive carcinoma.

Adult↗