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Biomedical subjects

J S Brooks

Publications and source records attributed to J S Brooks.

At least 19 recordsLinked to original sources

Sarcoidosis in a uterine leiomyoma.

Sarcoidosis is a granulomatous condition of unknown etiology. Though the lung and lymph nodes are most commonly involved, other organs may also be affected. Involvement of the female reproductive system is very uncommon and usually has been found in the endometrium or myometrium. A case is described of a 43-year-old nulligravida who presented for evaluation of a dry cough and who was found to have a pelvic mass. Preoperative evaluation revealed the presence of pulmonary sarcoidosis. At the time of exploratory laparotomy, a large, pedunculated fibroid was resected along with an inflammatory cyst. Histopathologic examination revealed the presence of sarcoid lesions within the fibroid. This is the first report of such a finding, and the implications are discussed.

Adult

Deletion 6q in three cases of mixed-type liposarcoma in addition to t(12;16)(q13;p11)

We report the cytogenetic findings in three mixed liposarcoma following short-term cultures. During the course of cytogenetic investigation of various types of liposarcomas, we observed an interstitial deletion of the long arm of chromosome 6 together with the translocation (12;16)(q13;p11) in three tumors. Translocation (12;16) is associated with myxoid and mixed (myxoid/round cell) liposarcomas, although deletion of chromosome 6 has been observed in only a few of these tumors. Our findings suggest that del(6), as an additional change in myxoid liposarcoma, is probably related to tumor progression.

Adult

Engraftment of gene-modified umbilical cord blood cells in neonates with adenosine deaminase deficiency.

Haematopoietic stem cells in umbilical cord blood are an attractive target for gene therapy of inborn errors of metabolism. Three neonates with severe combined immunodeficiency were treated by retroviral-mediated transduction of the CD34+ cells from their umbilical cord blood with a normal human adenosine deaminase complementary DNA followed by autologous transplantation. The continued presence and expression of the introduced gene in leukocytes from bone marrow and peripheral blood for 18 months demonstrates that umbilical cord blood cells may be genetically modified with retroviral vectors and engrafted in neonates for gene therapy.

Adenosine Deaminase

Primary cutaneous osteosarcoma.

A 78-year-old man had a 1-cm cutaneous nodule on his shoulder; subsequent excisional biopsy showed osteosarcoma. There was no connection to deeper structures, and no primary bone lesion was found. The tumor recurred at the same site 9 months after diagnosis and was reexcised. We believe this to be the first well-illustrated case of primary cutaneous osteosarcoma, which should now be included on the list of sarcomas that may occur in the skin.

Aged

Treatment of primary ovarian angiosarcoma with ifosfamide and doxorubicin.

Angiosarcoma originating in the female genital tract is exceedingly rare with only 15 cases of angiosarcoma of the ovary described to date. All have been highly aggressive tumors, and no response to treatment has ever been reported. A case of primary ovarian angiosarcoma is described in which a short remission was achieved with intensive chemotherapy using ifosfamide and doxorubicin.

Adult

Lipofibromatous hamartomas of the median nerve.

Five cases of lipofibromatous hamartoma of the median nerve are reported. The initial onset of symptoms and recognition of a mass occurred in adults in four cases. The fifth patient was an infant when the mass was first noticed, and she also had macrodactyly. Treatment included carpal tunnel release in three patients, one of whom required a second procedure for excision of the mass and sural nerve grafting. Nerve ablation without grafting was performed in the other two patients; one of these patients noticed no sensory or motor deficit after surgery. From this small series we cannot recommend a preferred treatment for these patients; each case must be approached on an individual basis. The diagnosis is best confirmed by biopsy.

Adolescent

Primitive neuroectodermal tumor of the chest wall in a patient with Jeune's syndrome and renal transplant.

Jeune's syndrome is a rare autosomal disorder characterized by osseous dysplasia, fetal respiratory distress, and renal failure in later life. We describe a 27-year-old man with Jeune's syndrome who underwent renal transplantation and 6 years later developed a sarcoma (primitive neuroectodermal tumor [PNET]) in the soft tissue of the chest wall, a principal site of dysplasia in this disorder.

Adult

Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas.

PURPOSE: This three-armed phase III study in adults with advanced soft tissue sarcomas was planned as a comparison of objective regression rates, toxicity, and survival of patients receiving doxorubicin alone, ifosfamide plus doxorubicin, and mitomycin plus doxorubicin plus cisplatin. PATIENTS AND METHODS: Between December 1987 and July 1990, 279 patients with histologically confirmed sarcomas were enrolled to receive treatment A (doxorubicin 80 mg/m2), treatment B (ifosfamide 7.5 g/m2 plus doxorubicin 60 mg/m2), or treatment C (mitomycin 8 mg/m2 plus doxorubicin 40 mg/m2 plus cisplatin 60 mg/m2). RESULTS: Of 262 assessable patients, 74 (29%) achieved objective tumor regression. Objective regression occurred in 20% of the 90 patients who received doxorubicin alone (complete remission [CR] rate, 2%), in 34% of the 88 who received ifosfamide plus doxorubicin (CR rate, 3%), and in 32% of the 84 who received mitomycin plus doxorubicin plus cisplatin (CR rate, 7%). With grade 3 or greater myelosuppression in 53% of group A, 80% of group B, and 55% of group C, regimen B was significantly more myelosuppressive than either regimen A or C (P = .01) with two, three, and one treatment-related deaths, respectively. Synovial sarcomas were responsive to ifosfamide plus doxorubicin, especially among patients younger than 40 years of age. CONCLUSION: Ifosfamide plus doxorubicin produced a significantly higher regression rate (P = .03) than did doxorubicin alone; however, this was achieved at a level of myelosuppression significantly more intense than that produced by the single agent or by the three-drug combination. Mitomycin, doxorubicin, and cisplatin also appeared to be more active than the single agent; however, at a myelosuppression level similar to that of doxorubicin alone, this trend (P = .07) did not attain the usual level for significance. No significant survival differences were observed.

Adult

Cellular angiolipoma of the breast.

Cellular angiolipomas are benign fatty tumors that occur as multiple subcutaneous nodules on the extremities and trunks of young adults. Although clinically benign, they may occasionally mimic Kaposi's sarcoma or angiosarcoma histologically. We report the first case of cellular angiolipoma occurring in the subcutaneous tissue of the breast, a rare but well-recognized site of benign and malignant vascular tumors.

Breast Neoplasms

Diabetic mastopathy: a distinctive clinicopathologic entity.

Insulin-dependent diabetics may manifest evidence of autoimmune diseases involving endocrine or other organs. Rare cases of a peculiar fibrous and inflammatory lesion of the breast in diabetic patients have been previously described; however, the pathologic and clinical features that uniquely characterize these cases have not been defined or distinguished from other chronic inflammatory and fibrosing conditions in the breast. We studied eight patients with breast masses and longstanding insulin-dependent diabetes and compared them with 36 nondiabetic or short-duration diabetic patients with fibrosis and chronic mastitis. The longstanding diabetic patients presented with clinical breast masses ranging in size from 2 to 6 cm. Six of the eight patients had documented diabetic nephropathy, retinopathy, or neuropathy. Pathologically, these lesions showed lymphocytic lobulitis and ductitis, lymphocytic vasculitis (predominantly B cell), and dense keloid-like fibrosis that in many cases (six of eight) contained peculiar epithelioid cells embedded in dense fibrous stroma. We have provisionally labeled these cells "epithelioid fibroblasts" (EFBs). Although the features of lymphocytic lobulitis, ductitis, and/or vasculitis may occasionally be encountered in nondiabetic breast biopsies, EFBs appear to be unique to the diabetic condition. Control cases of chronic mastitis in nondiabetic or short-duration diabetes patients failed to show the complete constellation of lymphocytic lobulitis and ductitis, vasculitis, keloidal fibrosis, and EFBs. Diabetic mastopathy may represent an immune reaction to abnormal matrix accumulation. A hypothesis is presented.

Adult

Lymphangiomyomatosis in the Atlantic bottlenose dolphin (Tursiops truncatus).

The first case of lymphangiomyomatosis in a marine mammal is reported from a stranded male Atlantic bottlenose dolphin (Tursiops truncatus). This progressive proliferative disease involved the lungs and the mediastinal and probably mesenteric lymph nodes. An extraordinarily low level of testosterone may have been pathologically significant since all reported cases of this disease in humans occur in females.

Animals

Mesothelial cell inclusions in mediastinal lymph nodes mimicking metastatic carcinoma.

The authors report two extremely unusual cases in which metastatic cancer was mimicked by mesothelial cell inclusions in mediastinal lymph nodes. The cells appeared only in the nodal sinuses and occurred predominantly as single individual cells and small clusters. The nuclei were bland, the N/C ratio was low, and the cell borders were well defined. So-called mesothelial windows were noted when cells formed groups; mitoses were not observed. Immunohistochemical analysis demonstrated the inclusions to be positive for cytokeratin (both AE1/3 and CAM5.2) but negative for epithelial membrane antigen, Leu-M1, and carcinoembryonic antigen. Nearly all cells were negative for B72.3; rare cells in one case contained unusual minute granular dot-like positivity in the region of the Golgi for this marker. The pattern of cytokeratin immunoreactivity was consistent with a mesothelial cell: namely, stronger immunoreactivity in a perinuclear location with some fading at the cell periphery. Ultrastructural analysis of both cases documented long microvilli processes consistent with a mesothelial origin. An extensive clinical workup in each case has failed to identify a primary carcinoma. It is interesting that both patients had a pleuritis with pleural effusion and both had mediastinal widening. In the first case, the exact cause of the benign pleural process was unknown but thought to be infectious. The second patient had follicular lymphoma in the same lymph node together with pleural involvement clinically and evidence of congestive heart failure. The patients are alive three years and ten months from diagnosis, respectively. Recognition of this new and previously unrecognized entity is important to prevent a diagnosis of carcinoma in such rare instances.

Adult

Relationship of extremity muscle torque and bone mineral density in postmenopausal women.

The purpose of this study was to examine the correlations between the torque of four extremity muscle groups and the bone mineral density (BMD) of the lumbar spine and hip in postmenopausal women. Fifty-six postmenopausal women (means age = 55.4 years, s = 7.1; means height = 162.6 cm, s = 6.4; means weight = 65.9 kg, s = 9.3) served as subjects. Bone mineral density was measured from the L2-L4 vertebral bodies, greater trochanter, femoral neck, and Ward's triangle using dual-photon absorptiometry. Hip abduction, knee extension, hip flexion, and grip force were assessed using the Spark Muscle Examination and Exercise Dosimeter (MEED) 3000 system. The Pearson product-moment correlations between muscle torque and BMD ranged from .07 to .42. The significant (p less than .05) correlations between torque and BMD (r = .27-.42) occurred in functionally and anatomically related areas. Results of this study demonstrate a statistically significant relationship between torque and BMD in anatomically related areas in postmenopausal women. This relationship, however, is not sufficiently strong to allow for prediction of BMD from the four muscle groups tested in this study. The relationship does suggest that strength may be a factor in the determination of BMD. Maintenance of strength in those muscle groups with anatomical or functional relationships to the hip and lumbar spine may play a role in the prevention and cessation of the osteoporotic changes that occur.

Body Weight

Leiomyomatous neoplasms of the lung: a clinical, histologic, and immunohistochemical study.

A series of 12 pulmonary lesions initially diagnosed as leiomyomatous in origin were reviewed. The original slides were analyzed for a series of histological features, the patients' charts were reviewed for clinical presentation and follow-up, and the usefulness of immunohistochemistry was assessed. Three groups were noted after analysis. Group 1, or benign lesions (three cases), all occurred in premenopausal female patients who remain alive and well. Group 2, or leiomyosarcomas (five cases), mostly occurred in older females, were thought to originate in the uterus, and resulted in death in four patients. In one of three cases of metastatic leiomyosarcoma, estrogen receptor was identified. Group 3 (4 cases) consisted of other diagnoses, including leiomyomatosis, fibrous histiocytoma, metastatic malignant melanoma, and metastatic synovial sarcoma. Immunohistochemistry was useful in separating nonsmooth muscle tumors and demonstrated muscle marker expression in all benign and most malignant smooth muscle lesions. Criteria are proposed for the diagnosis of pulmonary leiomyosarcoma, whether primary or secondary. In addition, if strict criteria are applied, the term "benign metastasizing leiomyoma" should be abandoned.

Actins

Diagnosis, treatment, and rehabilitation of injuries to the lower leg and foot.

The article provides an overview of specific lower-extremity and foot injuries. The areas of concentration are sinus tarsi syndrome, tendon injuries, stress fractures, ankle sprains, and plantar fascitis. Diagnosis, treatment, and rehabilitation techniques have been discussed for each injury. The authors have also included biomechanical treatment modalities using orthotics for rehabilitation of these injuries.

Athletic Injuries

The prognostic significance of myelonecrosis after induction therapy in acute leukemia.

Myelonecrosis is a rare antemortem finding in acute leukemia and its clinical significance is uncertain. The clinical events in nine patients with acute leukemia whose bone marrow biopsies after induction therapy revealed myelonecrosis were reviewed. No patient gained a complete remission and four patients achieved a partial remission. The median duration of survival was 2 months (range, less than 1 month to 8.5 months) from the start of therapy. Myelonerosis after induction therapy in acute leukemia indicates a very poor prognosis.

Acute Disease

Expression of neurofilament and neuron-specific enolase in small cell tumors of skin using immunohistochemistry.

Trabecular carcinoma of the skin (Merkel cell tumor), a neoplasm of putative neural origin, must be differentiated from other small cell tumors primary or metastatic to skin. In order to provide more objective diagnostic criteria, four were examined using monoclonal antibodies against neurofilament proteins (NF) and antiserum specific for neuron-specific enolase (NSE). Immunohistochemistry demonstrated immunoreactive NF in three and NSE in four cases. NF immunoreactivity was arranged in paranuclear balls, consistent with ultrastructural observations of aggregated intermediate filaments. A case of pulmonary oat cell carcinoma metastatic to the skin also contained immunoreactive NF and NSE. Although NF and NSE do not discriminate metastatic oat cell carcinoma from trabecular carcinoma of skin, they are useful antigens that provide objective criteria for recognizing tumors of neural histogenesis or neural differentiation. They should make it possible to exclude non-neural lesions from the differential diagnosis of small cell tumors of the skin.

Adolescent