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Biomedical subjects

J G Caya

Publications and source records attributed to J G Caya.

At least 19 recordsLinked to original sources
PubMed1991

Hyperplastic gastropathy. Clinicopathologic correlation.

Assessment of gastric histology in patients with hyperplastic gastritis is now possible using new endoscopic biopsy techniques that obtain a full-thickness gastric mucosal biopsy. Thirty-one patients with hyperplastic gastropathy and full-thickness gastric mucosal biopsies or gastric resections were seen during a 13-year period. Six patients had Zollinger-Ellison syndrome (ZE) with gastric gland hyperplasia; six had Menetrier's disease with foveolar hyperplasia and gland atrophy; and a single patient with hyperplastic hypersecretory gastropathy (HHG) was seen. The majority of patients, 18 of 31 with large folds, had peptic disease. The enlarged gastric folds were due to edema and inflammation. Discordant clinical findings and gastric pathology were seen in four patients: three of the 18 patients with peptic disease had histology typical of ZE (two patients) or Menetrier's disease. None of the three patients have developed a syndrome on follow-up ranging up to 5 years. Also, the patient with HHG had the gastric histology seen in Menetrier's disease. One patient with Menetrier's disease had areas of atrophic gastritis interspersed between the hyperplastic gastritis. In summary, the majority of patients with endoscopic hyperplastic gastropathy had gastritis on histologic examination. Most patients with a clinical syndrome associated with hyperplastic gastritis showed histology typical for the syndrome; however, clinical-histologic concordance was not absolute. In a small minority of cases, a patient with one clinical syndrome had the histology typical of another.

Adult↗
PubMed1991

Accuracy of breast frozen section diagnosis in the community hospital setting: a detailed analysis of 628 cases.

The author presents a detailed analysis of 628 breast frozen sections performed at Columbia Hospital over a 35-month period. These 628 frozen sections came from a total of 574 females and 13 males (mean age 55.3 years and range 20.1 to 95.0 years). Frozen section diagnosis was deferred in 18 cases (2.8%) and diagnostic accuracy for presence or absence of malignant neoplasia was 99.2%; one false positive case (pathologist judgement error) and four false negative cases (two sampling errors and two pathologist judgement errors) were detected. Strict diagnostic accuracy for this series was 98.7%. Fifty-three of 223 positive frozen sections (23.8%) were immediately followed by completion mastectomy. The author discusses the philosophy of frozen section technique and concludes that breast frozen section analysis in a busy community hospital setting can meet and even exceed the accuracy level attained at large academic medical centers.

Adult↗
PubMed1990

Lung cancer treated on the basis of cytologic findings: an analysis of 112 patients.

The authors studied 112 patients who received definitive radiotherapy/chemotherapy solely on the basis of positive cytologic findings in the appropriate clinical context. Eighty patients (71.4%) were treated on the basis of one or more positive sputum studies, while the remainder had at least one positive bronchial cytologic preparation. Eighty-six patients (76.3%) received radiotherapy alone; 19 received both radiotherapy and chemotherapy; only 7 were exclusively given chemotherapy. The utilization of stringent verification criteria revealed that none of our patients was falsely positive for malignancy. For those patients categorized as having malignant disease by verification criteria I-IV, there were no significant disparities between histologic and cytologic diagnoses. This study demonstrated, in a systematic fashion, that patients can be reliably and definitively treated for lung cancer on the basis of positive respiratory cytology findings without tissue corroboration.

Adult↗
PubMed1990

Laboratory identification of conditions predisposing to thrombosis.

The 5-year experience with a panel of laboratory tests designed to identify patients with high risk of thromboembolism was reviewed. This panel included an activated partial thromboplastin time and reptilase time as well as specific assays for antithrombin III, protein C, protein S, and plasminogen. One hundred and nine patients were evaluated by this panel. Conditions predisposing to thrombosis were identified in 24 of these patients and these conditions included: dysfibrinogenemia, lupus anticoagulant, and deficiencies of antithrombin III, protein C and protein S. The limitations of this panel are also discussed.

Adolescent↗
PubMed1989

Preoperative coagulation indices in patients with morbid obesity.

Preventive measures against venous thromboembolism are used frequently in surgical patients with morbid obesity because the risk has been claimed to be higher than usual. We addressed this risk in 81 morbidly obese patients by measuring preoperative plasma proteins associated with coagulation and by correlating variations in these indices to excess weight, liver histology, patient sex, tobacco use and serum triglycerides. Plasma levels of antithrombin III and plasminogen were normal in these patients. Plasma fibrinogen concentrations were elevated in 34 percent of patients; the values did not relate to excess weight and they correlated negatively (P less than 0.04) with increasing serum triglycerides and grades of liver fat content. Premenopausal women had higher plasminogen and fibrinogen levels than menopausal women or men, although their mean levels were normal. Smokers had lower plasminogen levels than nonsmokers (P less than 0.01). However, none of the measured levels of preoperative coagulation proteins identified increased risk for venous thrombosis in cohorts of this population, and the coagulation indices were not different from those reported in normal weight patients.

Anastomosis, Roux-en-Y↗
PubMed1988

The diagnosis of pulmonary small-cell anaplastic carcinoma by cytologic means: a 13-year experience.

This article reports on a series of 432 patients with positive respiratory (sputum and bronchial) cytology and proven malignant respiratory tract disease as corroborated by detailed verification criteria; 54 of these patients were diagnosed as having small-cell anaplastic carcinoma (SCAC). None of the 31 patients with autopsy-and/or biopsy-proven disease had false-positive results for SCAC. Typing accuracy for SCAC versus non-SCAC was 97.7% in the 263 patients with histologic confirmation of their respiratory tract disease. Twenty-three of the 54 patients (42.6%) were treated for SCAC solely on the basis of positive cytology in the context of compatible clinical data. This finding underscores the great importance of proper specimen preparation, quality control procedures, and diligent clinical follow-up in an era of heightened cost-containment awareness when many patients with pulmonary SCAC will be treated on the basis of positive cytology not immediately confirmed by histologic methods.

Bronchi↗
PubMed1988

Respiratory epithelial cyst of the orbit.

An 88-year-old woman presented with a longstanding superomedial cyst of the orbit complicated by recurrent acute infection. Despite a clinical picture typical for a sino-orbital mucocele, no sinus abnormality was demonstrated. Histopathologic examination revealed a respiratory epithelial lining similar to that of the paranasal sinuses. Possible pathogenetic mechanisms are discussed.

Aged↗
PubMed1988

Pityrosporum folliculitis after bone marrow transplantation. Clinical observations in five patients.

A skin rash in marrow graft recipients often poses difficult diagnostic problems because multiple causes may be implicated, and clinical and histopathologic findings may be nonspecific. Five recipients of allogeneic bone marrow transplants had pityrosporum folliculitis diagnosed by skin biopsy in the early weeks (less than 18 days) after transplantation. In all cases, patients were febrile and leukopenic (granulocyte count, less than 500 cells/mm3), and were receiving broad-spectrum antibiotics at onset of the skin rash. Erythematous macules and papules were distributed primarily over the chest, shoulders, and upper back, and pustules and crusts developed in some cases. Granulocyte counts of more than 500 cells/mm3 were associated with resolution of the rash. Pityrosporum infection should be considered in the differential diagnosis of skin rashes in marrow graft recipients.

Adult↗
PubMed1987

Intraocular Echinococcus multilocularis.

Alveolar hydatid disease, caused by the organism Echinococcus multilocularis, is a potentially lethal helminthic infection. After initial hepatic infestation, the organism may spread locally and hematogenously to distant sites. Death occurs secondary to hepatic failure, local extension into vital structures, or metastasis to the brain or lungs. A 67-year-old male Alaskan Eskimo developed decreased visual acuity secondary to a choroidal mass in the right eye eight years after an initial diagnosis of alveolar hydatid disease and four years before the development of symptomatic cerebral metastasis. A pathologic examination disclosed characteristic parasitic membranes involving the posterior pole of the right eye. To our knowledge, this is the first report of ocular involvement in alveolar hydatid disease.

Aged↗
PubMed1986

Clostridial septicemia complicating the course of leukemia.

The authors report an analysis of 47 leukemia patients (including 9 from our own medical center) whose courses were complicated by 48 episodes of clostridial septicemia. There were 36 adults and 11 children; acute myelogenous leukemia and acute lymphoblastic leukemia accounted for 61.7% and 14.9% of cases, respectively. All patients for whom remission status was known were in leukemic relapse. Fever was a presenting complaint in at least 36 patients whereas neutropenia, thrombocytopenia, and gastrointestinal lesions were noted in 100%, 90.9%, and 87.9%, respectively, of the patients for whom information on these parameters was available. Overall mortality from clostridial septicemia was 78%; none of the children and none of the patients with intravascular hemolysis survived. Overall, antibiotic therapy resulted in a 40% survival rate. However, among patients receiving beta lactam and/or chloramphenicol therapy, 57% survived their episode of clostridial septicemia. Prompt initiation of appropriate antimicrobial therapy offers the best chance of survival in leukemia patients with clostridial septicemia.

Adolescent↗
PubMed1986

The morphologic spectrum of large gastric folds: utility of the snare biopsy.

The differential diagnosis of large gastric folds is diverse, and endoscopic biopsies are often too small to permit adequate morphologic evaluation. This article describes the morphology of large gastric folds obtained by electrosurgical endoscopic snare biopsy in a series of 52 patients. The great majority of patients with enlarged rugae presented with peptic ulcer symptoms. This series included 16 patients with hyperplastic gastropathies, 15 with chronic nonspecific gastritis, seven with gastric polyposis, three with adenocarcinoma, five with benign lymphoid hyperplasia, and the remainder with miscellaneous conditions. In all cases, the snare biopsy provided a full thickness mucosal biopsy adequate to fully evaluate the enlarged rugae.

Biopsy↗
PubMed1986

Wound healing of true vocal cord squamous epithelium after CO2 laser ablation and cup forceps stripping.

A study was conducted on the effect of deepithelization of the true vocal cords; microcup forceps were used, as opposed to CO2 laser ablation. A CO2 laser, coupled to an operating microscope, was used to ablate the surface epithelium of the right true vocal cords in eight canines, while conventional microlaryngeal stripping was performed on the left true cords in the same animals. Photographs were taken immediately after injury and again before the animals were killed. Histologically, the series of true vocal cords ablated by the CO2 laser revealed granulation formation at day 5, whereas those treated with conventional stripping developed granulation at day 3, thus indicating delayed healing. Charred carbonaceous debris of CO2 laser ablation was found to cause a giant cell reaction that persisted after reepithelization. Despite the precise control offered by the laser, many of the laser-injured true vocal cords revealed vocalis muscle edema and muscle destruction. After healing occurred, dense fibrosis was found in the vocal muscle injured during CO2 laser ablation of the overlying squamous epithelium.

Animals↗
PubMed1986

Role of leukocytes in ocular inflammation of tyrosinemia II.

In the animal model of tyrosinemia II only corneas from tyrosine(tyr)-fed rats produce chemoattractants in organ culture. To study the role of neutrophils (PMNs) in production of these chemoattractants, leukocytes (WBCs) were depleted using i.p. cyclophosphamide (CP). Saline (SAL)-treated rats maintained 18,375 +/- 894 WBC/mm3 (mean +/- SEM) with 4168 +/- 424 PMNs. Rats receiving CP (150 mg/kg day 0, 75 mg/kg day 4) has 1565 +/- 170 WBC (565 +/- 129 PMN) on day 3, and 398 +/- 68 WBC (19 +/- 5 PMN) on day 8. Rats ate a low-protein +/- 5% tyr diet on days 4-8. Only SAL-treated tyr-fed rats developed plaque-like gray epithelial lesions; histopathology showed corneal epithelial necrosis, stromal edema, and epithelial and stromal PMN infiltration. Control and CP-treated tyr-fed rat corneas showed no inflammation. On day 8 corneas were cultured in RPMI 1640 + 5% heat-inactivated fetal bovine serum. After 3 days, supernatants were assayed for chemotactic activity (leading front method); data were expressed as the percentage of peritoneal PMN migration relative to 5% zymosan-activated rat serum. The mean total migration toward 75% supernatant from SAL-treated, tyr-fed rat corneas was 79%, whereas migration toward corneal supernatants from controls and CP-treated tyr-fed rats ranged from 42-48%. Corneal extracts were assayed for proteolytic activity. WBC depletion prevented the increase in cathepsin B- and D-like activities present in tyr-fed corneas, suggesting that PMNs were a major source of these enzymes. The data suggest that WBC depletion reduces both corneal inflammation in vivo and the production of chemotactic activity by tyr-fed corneas in culture.

Animals↗
PubMed1985

A clinicopathologic study of 21 cases of adenoid squamous cell carcinoma of the eyelid and periorbital region.

We conducted a clinicopathologic study of adenoid squamous cell carcinoma involving the eyelid (15 cases) and periorbital region (six cases). The mean age of the 17 men and four women was 64.5 years (range, 43 to 85 years). Histopathologically, the lesions were characterized by acantholysis and a pseudoglandular pattern with many alveolar and tubular structures. Solar keratosis was also a prominent histologic feature, suggesting that exposure to the sun was a predisposing factor. Local recurrences occurred in five of 16 patients for whom follow-up information was available (mean follow-up period, 8.8 years). There was no regional lymph node or distant metastasis, and none of these patients died of their neoplastic disease. Surgical excision appears to be the best treatment.

Adenocarcinoma↗
PubMed1985

Respiratory cytology: significance of "suspect" results in a series of 435 patients.

We reviewed all "suspect" results of respiratory cytology obtained over a ten-year period at our medical center. There were 435 patients with one or more "suspect" respiratory cytology determinations who were classified as having benign or malignant respiratory tract disease by using a system of detailed, reproducible verification criteria; 61.8% of them had malignant disease. Patients with "suspect" bronchoscopic determinations and those thought to have a specific type of neoplasm were found to have significantly more malignant respiratory tract disease than patients lacking these parameters, though diagnostic efficiency values for these characteristics were low (54.0% and 61.8%, respectively). The most common causes of benign respiratory disease (167 patients) were pneumonia (38.9%) and mycobacterial infection (21.6%). Our data indicate that "suspect" respiratory cytology diagnoses (even bronchoscopic and those suggesting a specific type of malignancy) represent an indeterminate group requiring further evaluation before therapeutic action is taken.

Bronchi↗
PubMed1984

The significance of "positive" respiratory cytology determinations in a series of 327 patients.

The authors reviewed all "positive" respiratory cytology diagnoses rendered over the past ten years at a medical center. Three hundred twenty-seven patients (with a total of 689 "positive" respiratory cytology determinations) were classified as having nonmalignant respiratory tract disease by using a unique system of explicit, reproducible verification criteria. Five patients with false-positive results (1.5%) and seven false-positive patient determinations (1.0%) were encountered. None of these were typed cytologically as small cell anaplastic carcinoma, and none were bronchial determinations. Overall patient typing accuracy was 72.2%; 75.2% of all sputum and 61.2% of all bronchial determinations were typed accurately. Our lowest typing accuracy (53.3%) was encountered in patients with poorly differentiated carcinoma. The findings from this study confirm the continued need for systematic analysis of respiratory cytology data from large groups of patients. Only then can cytopathologists hope to improve upon the clinical value of this diagnostic modality.

Bronchi↗