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Biomedical subjects

J J Rippey

Publications and source records attributed to J J Rippey.

16 recordsLinked to original sources
PubMed1979

The presentation of malignant melanoma.

Survival figures for patients with malignant melanoma in South Africa compare rather unfavourably with those from other countries, for example Queensland, Australia. The chief reason for this seems to be the late stage at which patients present with the tumour and hence the late diagnosis of melanoma in this country. A series of patients was studied and note was taken of their presenting symptoms and signs, which included growth of a pigmented lesion, bleeding, darkening, pain, tenderness and itching. Ulceration and satellitosis had developed in a small proportion of cases. Awareness of this tumour and education as to the circumstances in which it should be suspected should be encouraged, so as to ensure earlier diagnosis and treatment and thus higher survival rates.

Female↗
PubMed1979

Dilatation and curettage.

A retrospective study was undertaken in which the histopathology reports on 1,000 specimens of endometrial curettings were reviewed in order to assess the value of pathological examination of the endometrium. In this series the reports were of use in only one-half of the specimens submitted. A seemingly high proportion of specimens was unsuitable for histological assessment. The main factors contributing to the pathologist's inability to provide a useful report appear to be inadequacy of the specimen and a lack of information regarding the clinical and menstrual history. Alternative methods of endometrial sampling are also briefly reviewed.

Adolescent↗
PubMed1978

Articular cartilage degradation and the pathology of haemophilic arthropathy.

Synovial membrane and specimens of articular cartilage, obtained from the affected knee joints of 5 haemophilic patients at the time of surgical synovectomy, were studied. All the synovial specimens showed villous proliferation and multiplication of synovial cells. Haemosiderin granules were present within synovial cells and in macrophages. There was congestion and capillary proliferation. An inflammatory infiltrate of plasma cells and lymphocytes was seen in some instances. Articular cartilage changes were classified into the following 4 grades according to severity: 1--an increase in the number of surface chondrocytes with fibrous metaplasia, and the appearance of superficial fissures; 2--a fibrous vascularized overgrowth, resembling rheumatoid pannus; 3--deep fissuring and necrosis of cartilage; 4--erosion and disappearance of articular cartilage with exposure of subchondral bone. In the first 3 grades, deep nests of chondrocytes containing haemosiderin were present. These cell aggregates became larger and more degenerate as cartilage degradation progressed. Damaged articular cartilage was deficient in glycosaminoglycan (acid mucopolysaccharide). No excess enzyme activity could be demonstrated within the cartilage matrix. Immunofluorescent studies were not helpful. Electron microscopical examination revealed siderosomes within degenerate chondrocytes and synovial cells. Granules resembling haemosiderin were also present in the cartilage matrix. It is considered that iron products affect both chondrocytes and matrix adversely and play a part in articular cartilage destruction in haemophilia.

Adolescent↗
PubMed1978

Acral lentiginous melanoma or Hutchinson's melanotic freckle of the extremities. A case report.

An additional category of malignant melanoma of the skin, i.e. acral lentiginous melanoma, has been proposed by some authors. The lesion occurs on the extremities, particularly the soles of the feet, the palms of the hands and the digits, but otherwise has the clinical, histological and prognostic features of Hutchinson's melanotic freckle with melanoma. A case conforming to the description of Hutchinson's melanotic freckle of the sole of the foot occurring in a White patient is described. Reference is also made to previous studies of malignant melanoma of the extremities in Black patients. In 15% of these the histogenetic pattern of Hutchinson's melanotic freckle could be observed in the epidermis, adjacent to the invasive melanoma. This pattern was associated with a very much better prognosis than was the superficial spreading or nodular type. The advisability of introducing a new category of acral lentiginous melanoma is therefore questioned.

Female↗
PubMed1977

Malignant melanoma of the skin in Johannesburg Whites.

One hundred and thirty patients with malignant melanoma, of whom 108 could be followed up, are reviewed. Malignant melanoma of the skin in South African Whites kills 2,2 per 100 000 population per annum and its incidence increases with age. The tumour was commoner in females, but has a better prognosis than in males. The overall 5-year survival rate was 43% (46 out of 108 patients). The bigger lesions have a worse outlook.

Adolescent↗
PubMed1977

Malignant melanoma with adjacent Hutchinson's melanotic freckle in Black Africans.

Hutchinson's melanotic freckle (lentigo maligna) is a well-known pigmented lesion, usually seen on the face of white patients. It may be associated with invasive malignant melanoma. This paper reports the incidence of this lesion in association with invasive malignant melanomas of the feet and hands of Black Africans. In Blacks, as in Whites, malignant melanoma with adjacent Hutchinson's melanotic freckle carries a considerably better prognosis than other histogenetic patterns of malignant melanoma.

Black or African American↗
PubMed1976

Foot pigmentation in Blacks.

Pigmentation of the soles of the feet was studied during postmortem examination of 70 Black patients. Forty-eight (57%) showed some pigmentation (grade II) of the soles of the feet and 4 (6%) showed definite black spots, i.e. focal areas of dense black pigmentation (grade III). A distinction between clinical grade II or grade III lesions could not be made on the basis of microscopic appearance. No true naeyi were seen. Increases of melanin pigmentation and minor degrees of melanocytic proliferation were all that was apparent. Although the development of malignant melanoma may be related to the presence of black spots on the feet of darkly pigmented races, all such spots are certainly not naevi.

Adolescent↗
PubMed1976

A survey of snakebit in the Johannesburg area.

Case records of persons with snakebite treated at the Johannesburg General Hospital and the Transvaal Memorial Children's Hospital during the 10-year period 1963-1972 were investigated. It was concluded that (i) snakebites were rare, since only 39 cases were recorded, none of which ended fatally; (ii) 86% of patients were men (mean age was 24 years); (iii) 80% of bites were on the hand and arm; (iv) 28% of patients had had previous snakebites; and (v) 60% of bites were 'illegitimate', i.e. they occurred in snake handlers. Apart from occasional bites by exotic snakes in collections, the venomous snakes responsible for the majority of bites were, in order; ringhals, puff adder, and burrowing adder. The first two snakes are common in the region, while amateur herpetologists are at particular risk of being bitten by burrowing adders because of the snake's ability to bite even when held by the back of the neck. Ringhals bites, although the most common, caused virtually no morbidity. Bites by other venomous snakes showed considerable variation in morbidity, suggesting that many different factors must be taken into account when the nature and effects of snakebite are assessed. Eighty-five per cent of snakes were positively identified, mostly by the snake fanciers they had bitten. This permitted specific treatment.

Adolescent↗
PubMed1976

Angio-immunoblastic lymphadenopathy. A report of 3 cases.

Angio-immunoblastic lymphadenopathy (AILD) was diagnosed in 3 Black patients, AILD is a non-malignant disorder which resembles a malignant lymphoma clinically and morphologically. It is thought to represent an abnormal response of B lymphocytes to antigenic stimuli which are often therapeutic agents. The disorder usually affects adults of the older age group and the clinical course can be rapidly fatal, particularly if vigorous chemotherapy is given. Of the 3 patients with AILD, 2 died from complicating infections within 6 months after the initial diagnosis. The third patient was completely cured after short courses of prednisone and vincristine. It appears that in some patients the disorder may be completely reversible but whether these patients are at a greater risk of eventually developing a lymphoma is uncertain at the present time, and remains to be ascertained by their long-term follow-up.

Adult↗
PubMed1975

Pathology of malignant melanoma of the skin in Black Africans.

Follow-up data (over a 3-year period) and the histological appearances of primary lesion were studied and related in 40 Black patients with malignant melanoma. This to our knowledge is the first study in Black African patients. It was found that they present with large deeply invasive lesions, particularly on the foot. The prognosis is poor, with an over-all 3-year survival rate of 35%. The histological features used to assess the prognosis of malignant melanoma in Whites, that is histogenetic pattern, size and shape of the lesion, level of invasion, presence of ulceration and mitotic activity would seem to be equally applicable in Black patients. In addition, marked cellular pleomorphism, haemorrhage, necrosis and fibrosis within the tumour are bad signs. In this series lymphocytic infiltration, either within the tumour or at the edge, possibly indicative of an immune response, seemed to be of favourable prognostic import. Surprisingly, a lesion histologica-ly that of lentigo maligna melanoma was found on the feer of some blacks and could be related to much more favourable survival figures.

Black or African American↗
PubMed1975

The role of the autopsy in modern medical practice. A review.

The role of the autopsy in modern medical practice is reviewed in the light of waning clinical interest. After a historical introduction, the reasons for this lessening interest in the autopsy, its values and its limitations are discussed, and followed by consideration of the possible future pattern of postmortem investigation.

Attitude of Health Personnel↗
PubMed1975

Malignant melanoma of the skin in Black Africans.

Malignant melanoma of the skin in Blacks in formidable and sinister tumour. This study is concerned with the epidemiology of malignant melanoma, as seen in both urban and rural Black Africans. A smaller series in which follow-up on the patients was available is included. To our knowledge, this is the first study of its kind in which follow-up, and hence survival figures, can be quoted. Although the numbers are relatively small, they provide a valuable indication of the behaviour of melanomas in this group. The difficulties of follow-up cannot be overemphasised, and follow-up on 79 cases out of 100 could be obtained only by the employment of an able and enthusiastic Black social worker for 3 years. The first recorded survival figures in a Black population show a 3-year survival rate of only 28,4%. Prognosis is related to the size and extent of the tumour with larger and more widespread tumours faring worse than others. The incidence of malignant melanoma in Johannesburg Black was 1,2 per 100 000 and accounted for 2% of all cancers. The largest number of cases occurred in the 50- 70-year age group and there was a female preponderance. As in previous studies, the sites predominantly affected were the foot and the hand, mainly on the plantar and palmar surfaces.

Adolescent↗
PubMed1975

Extramedullary plasmacytoma of the breast.

The clinical and histopathological features of a case of solitary extramedullary plasmacytoma of the breast are described. After 46 mth of follow-up, there has been no recurrence of the tumour, and no evidence of further extramedullary plasmacytomas, multiple myeloma or diffuse myelomatosis either clinically, radiologically or on biochemical and haematological investigations. She has developed diabetes mellitus. Distinction is made between the true extramedullary plasmacytoma and those which are a manifestation of multiple myeloma. The unpredictable behaviour and prognosis of extramedullary plasmacytomas is indicated.

Breast Neoplasms↗