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K H van Hoeven

Publications and source records attributed to K H van Hoeven.

At least 19 recordsLinked to original sources
PubMed1999

Association between a shift in vaginal flora on Papanicolaou smear and acute chorioamnionitis and preterm delivery.

Bacterial vaginosis has been implicated as a cause of acute chorioamnionitis and preterm delivery. This study was designed to determine any association between the detection of bacterial vaginosis on a prenatal Papanicolaou (Pap) smear, defined as a shift in vaginal flora, and the subsequent occurrence of acute chorioamnionitis or preterm labor. A 47-mo retrospective case-control analysis comparing 186 patients with histologically-proven acute chorioamnionitis (cases) and 186 controls was performed. Initial prenatal Pap smears were evaluated for the presence of altered vaginal flora. Pap smears from women with acute chorioamnionitis were more likely to have altered vaginal flora than those without chorioamnionitis (P < 0.01). Preterm delivery was also more common among women with a shift in vaginal flora (P < 0.01). In conclusion, women at risk for chorioamnionitis and/or preterm delivery may be able to be identified by the results of their prenatal Pap smear.

Acute Disease↗
PubMed1998

Immunocytochemical evaluation of HBME-1, CA 19-9, and CD-15 (Leu-M1) in fine-needle aspirates of thyroid nodules.

Overlapping morphologic patterns that may be observed in goiter, follicular adenoma, and papillary carcinoma can limit the cytologic evaluation of the thyroid gland. In an attempt to develop a useful adjunctive test, the immunocytochemical reactivity of HBME-1, carcinoma antigen 19-9 (CA 19-9), and CD-15 (Leu-M1) was tested on 59 cell block preparations from fine-needle aspirations of the thyroid gland. HBME-1 monoclonal antibody was reactive in all 21 papillary carcinomas, in 4 of 18 adenomas, and in 5 of 20 goiters. CA 19-9 was identified in 13 of 21 carcinomas, 1 goiter, but none of the adenomas. CD-15 was present in 15 of 21 carcinomas, 1 goiter, and 1 adenoma. We conclude that HBME-1 is a sensitive marker of papillary thyroid carcinoma. CD-15 and CA 19-9 are less sensitive but more specific. This panel can be useful to help classify morphologically equivocal lesions. As with all immunocytochemical testing, caution must be exercised in the interpretation of results, and correlation made with morphologic and clinical data.

Adenoma↗
PubMed1997

Distinction between bronchioloalveolar carcinoma and hyperplastic pulmonary proliferations: a cytologic and morphometric analysis.

The objectives of this study were to identify key cytologic features for the morphologic differentiation of bronchioloalveolar carcinoma from reactive pulmonary proliferations, and to determine if morphometry of the cytologic specimens could provide additional data to distinguish the two processes. We analyzed 15 morphologic criteria in pulmonary cytologic specimens from 17 histologically proven cases of bronchioloalveolar carcinoma and 13 cases with reactive cellular changes and compared the findings using univariate analysis. This revealed four statistically significant features more commonly associated with bronchioloalveolar carcinoma: (i) predominance of two- and three-dimensional tissue fragments, (ii) tenacious intercytoplasmic connections between cells, (iii) intranuclear cytoplasmic inclusions, and (iv) paucity of multinucleated cellular forms. Morphometric measurement revealed significant differences between the mean of the nuclear area of benign reactive cells and that of the malignant cells. The utilization of these criteria is helpful to diagnose bronchioloalveolar carcinoma and to distinguish it from reactive pulmonary processes.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1997

Cytologic diagnosis of fat emboli in peripheral blood during sickle cell infarctive crisis.

A diagnosis of fat emboli can be suspected in a patient presenting with the typical symptoms of the fat embolism syndrome, but is rarely proved pathologically, except at autopsy. We described a 25-yr-old man with sickle cell anemia who developed an infarctive crisis complicated by unexplained fever, neurologic change, and respiratory abnormalities. Blood drawn from the femoral vein and examined cytopathologically yielded necrotic bone marrow elements admixed with fat. The cytologic finding of fat emboli from necrotic bone marrow provided the diagnosis and helped guide subsequent medical intervention. This sample test is recommended for patients at risk for fat emboli to aid in the clinical diagnosis.

Adult↗
PubMed1997

Ki-67 antigen staining as an adjunct to identifying cervical intraepithelial neoplasia.

The purpose of the work was to determine the feasibility and predictive value of Ki-67 immunostaining of cervical cytology and the detection of cervical dysplasia. Air-dried cervical smears were stained with MIB-1 antibody to identify the Ki-67 antigen. Nuclear decoration in abnormal squamous nuclei determined immunoreactivity. One hundred twenty-four nonpregnant patients underwent colposcopy and directed biopsies for abnormal cytology. Sensitivity (0.89), specificity (0.65), positive predictive value (0.60), and negative predictive value (0.91) were found for Ki-67 immunostaining in detection of high-grade cervical intraepithelial neoplasia (CIN) in 124 patients and positive Ki-67 staining was a significant predictor of high-grade CIN in both univariate (odds ratio 15.5 (95% CI 5.5-43.8) and multivariable (odds ratio 21.5 (95% CI 5.0-92.0) analysis. In 101 patients with ASCUS and LGSIL, Ki-67 immunostaining demonstrated the following in detection of high-grade CIN: sensitivity (0.96), specificity (0.67), positive predictive value (0.49), and negative predictive value (0.98). Ki-67 immunostaining of cervical cytology is a predictor of significant cervical pathology with high sensitivity and negative predictive value. Ki-67 immunostaining of cervical cytology may represent a new and cost-effective triage tool for patients with minor abnormalities on cytology.

Adolescent↗
PubMed1997

Review and hypothesis: the eosinophil and peripartum heart disease (myocarditis and coronary artery dissection)--coincidence or pathogenetic significance?

OBJECTIVES: To examine a possible relationship between peripartum heart disease (myocarditis and spontaneous coronary dissection) and the presence of eosinophils. BACKGROUND: Eosinophils have been shown to have potential collagenolytic and cytotoxic activity. Eosinophils may play a role in postpartum uterine involution. The presence of eosinophils in spontaneous coronary dissection and myocarditis in the postpartum period raises the possibility of a role for eosinophils in these diseases. METHODS: We reviewed the files of one of us (S.M.F.) for cases of peripartum myocarditis and spontaneous coronary dissection and assessed the frequency of eosinophilic inflammation. Seventeen postpartum myocarditis and/or cardiomyopathy cases were found and two spontaneous coronary dissections. Fifteen sex- and age-matched controls on non-postpartum myocarditis and borderline myocarditis were evaluated and eosinophil counts per unit area compared. Also, a Medline search of all previously published cases of spontaneous coronary dissection was performed back to 1966. RESULTS: Of the 16 heart biopsies and one autopsy in the peripartum period, 10 were shown to contain easily identified eosinophils (6 myocarditis, 1 borderline, 3 cardiomyopathy). When presence of eosinophils was compared with the control group, a statistically significant difference was obtained (P = 0.036). The two new spontaneous coronary dissection cases had eosinophils along the dissection plane; the literature search produced 13 of 24 autopsied peripartum spontaneous coronary dissections with eosinophils for a total of 15 of 26 with our cases. CONCLUSIONS: An association exists between eosinophils and peripartum cardiac disease (myocarditis and spontaneous coronary dissection). The role of eosinophils in labor, uterine involution and collagenolysis and the possible relation to cardiac disease are discussed.

Aortic Dissection↗
PubMed1997

Quantitative image analysis of MIB-1 reactivity in inflammatory, hyperplastic, and neoplastic endocervical lesions.

The diagnosis of endocervical neoplasia can be difficult as it is sometimes mimicked by proliferative or reactive glands. MIB-1 is a proliferation marker that can aid in the diagnosis of squamous intraepithelial lesions (SIL) of the cervix and vulva, but its potential value in the diagnosis of endocervical lesions has not been fully explored. Ten formalin-fixed, paraffin-embedded cases of each of the following were obtained: morphologically normal endocervical glands from patients with cervical SIL, endocervicitis, microglandular hyperplasia (MGH), and endocervical adenocarcinomas (eight in situ, two invasive). Microwave unmasking of antigens was performed prior to immunohistochemical staining for MIB-1 using the avidin/biotin peroxidase method. Labeling indexes were calculated for 34 specimens (10 adenocarcinoma. 8 each of the other diagnoses) using image analysis (Samba 4000). There was diffuse MIB-1 reactivity in adenocarcinoma (labeling index 57-96%, mean 80%), minimal focal reactivity in normal glands underlying SIL (labeling index 0.8-4.3%, mean 2.4%), moderate spotty reactivity in MGH (labeling index 2.9-18.4%, mean 8.5%), and minimal to focally diffuse reactivity in endocervicitis (labeling index 1.0-13.3%, mean 5.7%). These data indicate that the percentage and distribution of MIB-1-reactive endocervical cells can be of diagnostic utility in distinguishing neoplastic glands from those of endocervicitis and MGH.

Adenocarcinoma↗
PubMed1996

Cytology of small cell carcinoma of the urinary bladder.

To characterize the cytologic spectrum of small cell carcinoma of the urinary bladder, a review of 42 urinary cytology specimens from 13 patients with histologically proven tumors was conducted. Patients ages ranged from 45 to 81 yr (mean 68.9). In four tumors, small cell carcinoma was the sole malignant cellular component: all 11 urinary specimens in these patients harbored cells with features of an undifferentiated small cell carcinoma. In the remaining nine tumors, small cell carcinoma appeared with transitional, squamous cell or adenocarcinoma, but in four, small cell carcinoma was the sole invasive component. Almost one third of urinary specimens in this group lacked a small cell component. Neuroendocrine differentiation was confirmed by immunopathology in eleven cases (neuron specific enolase positive in 11 of 12, synaptophysin in 2/11, chromogranin in 2/13, Leu 7 in 2/7), and by ultrastructural analysis in two. Small cell carcinoma is a cytologically recognizable variant of bladder cancer, but admixture with other malignant components may mask its appearance in urinary specimens.

Aged↗
PubMed1996

Cytology of the thyroid gland: pitfalls in aspiration of the fibrotic nodule.

Fibrotic changes can be found in a variety of pathologic processes that affect the thyroid gland, and yet fine-needle aspiration (FNA) correlation of these lesions is not well-known. Cytologic findings are described from three different lesions, all with extensive fibrosis, that occurred in thyroid gland FNA. In each case, fibrotic changes resulted in cytologic changes potentially representing pitfalls in aspiration diagnosis. FNA revealed, solely or predominantly, fibroblasts in 2 patients whose subsequent thyroidectomies disclosed diffusely sclerotic papillary carcinoma and multinodular goiter. In the third case, an initially suspicious FNA was followed by multiple unsuccessful attempts at a second FNA. At thyroidectomy, a follicular adenoma with post-FNA fibrosis and infarction was identified. The differential diagnoses in thyroid FNA of fibrotic nodules can be broad, and this is discussed. Awareness of potential pitfalls may improve diagnostic accuracy.

Adult↗
PubMed1996

Cytologic features of pulmonary malakoplakia related to Rhodococcus equi in an immunocompromised host.

Cytologic features are described in bronchial brushings of a large cavitary lung mass from an immunosuppressed patient who had undergone liver transplantation. Scattered histiocytes with abundant eosinophilic, vacuolated cytoplasm were noted in a background of bronchial cells. Within approximately one fourth of the histiocytes, targetoid intracytoplasmic inclusions were present, consistent with Michaelis-Gutmann bodies. They were diffusely positive by histo-chemical staining with von Kossa, Gomori methenamine silver, and periodic acid-Schiff stains, and focally positive with Prussian blue stain. Cultures of the abscess yielded Rhodococcus equi. The characteristic microscopic features of pulmonary malakoplakia can be discerned in bronchial brushings, and should be sought, particularly in immunocompromised patients.

Cytodiagnosis↗
PubMed1996

Myocardial alterations in diabetes and hypertension.

Diabetes mellitus is a complex group of diseases that has hyperglycemia as a common metabolic abnormality. Although it is well-known that diabetic patients are susceptible to the effects of large vessel atherosclerosis with specific cardiac and cerebral complications, the association of diabetes mellitus with cardiac dysfunction caused by cardiomyopathy in the absence of significant coronary artery disease has been recognized for many years. However, the pathogenesis of diabetic cardiomyopathy remains unknown and has been somewhat controversial. Specifically, whether diabetes mellitus with its metabolic effects is sufficient to account for cardiomyopathy remains to be proven. This paper reviews the evidence for and against a metabolic etiology. In addition, we review the clinical and experimental evidence that supports the view that diabetes mellitus acts together with hypertension to produce structural damage in the heart that manifests as ventricular dysfunction and ultimately congestive heart failure. The concomitant effects of the metabolic derangements of diabetes and the vascular abnormalities associated with hypertension may lead to microvascular-induced tissue injury. Findings supporting this hypothesis are presented, along with observations suggesting that treatment with vasodilating calcium channel blockers or angiotensin converting enzyme inhibitors may be beneficial in regard to tissue pathology and mortality in experimental models. Recent clinical studies also support a role for the microcirculation in diabetics. Finally, it is suggested that if the microcirculation is pathogenetically involved in diabetic cardiomyopathy, then agents that improve microcirculatory flow along with tight control of hypertension may be as beneficial in the treatment or prevention of diabetic cardiomyopathy as strict metabolic control of hyperglycemia.

Cardiomyopathies↗
PubMed1996

Immunohistochemical staining for proliferating cell nuclear antigen, BCL2, and Ki-67 in vulvar tissues.

Dysplastic cells of the uterine cervix commonly react with antibodies to Ki-67 and proliferating cell nuclear antigen (PCNA), but less is known regarding the reactivity of vulvar lesions. Paraffin-embedded slides from seven normal vulvar tissues, eight cases of lichen sclerosus, and 10 cases of vulvar intraepithelial neoplasia (VIN), many with associated condylomatous changes, were immunostained with antibodies to PCNA, Ki-67, and BCL2 protein, a protooncogene product normally expressed only in basal cells of squamous epithelium. Ki-67 and PCNA nuclear staining was largely restricted to basal and parabasal cells in normal tissues and lichen sclerosus. Focal midepithelial staining with PCNA and Ki-67 was seen in one case of lichen sclerosus; a vulvar biopsy of this patient 1 year later was negative for VIN. Both antibodies stained dysplastic cells at higher epithelial levels in VIN, but Ki-67 was more consistently reactive and showed a sharper distinction from adjacent histologically uninvolved epithelium compared to PCNA. Condylomatous changes were variably stained. The pattern of BCL2 staining was identical in normal vulva, lichen sclerosus, and VIN, but BCL2 decorated occasional mitotic figures in VIN. Overall, Ki-67 was a better marker of vulvar dysplasia than PCNA.

Adult↗
PubMed1996

Protocol for immunocytochemical detection of SIL in cervical smears using MIB-1 antibody to Ki-67 [corrected].

Ki-67 nuclear antigen is expressed in upper epithelial levels of intraepithelial neoplasia of the cervix and vulva, variably in condyloma, and in basal and parabasal cells of normal squamous mucosa in histologic preparations. The application of antibodies to Ki-67 as a marker of squamous intraepithelial lesions in cervical smears was explored using either air-dried, acetone-fixed cervical smears obtained from 106 consenting patients or a single slide from archival two-slide cases of squamous intraepithelial lesions MIB-1 monoclonal antibody to Ki-67 was tested using two immunocytochemical techniques. In one set of smears, avidin-biotin peroxidase was used for detection and diaminobenzidine with H2O2 as the chromogen. Some specimens were incubated with 0.3% H2O2 and phosphate buffered saline for blockade of endogenous peroxidase. Alternatively, other air-dried smears were stained using alkaline phosphatase antialkaline phosphatase for detection and new fuchsin as the chromogen. Nuclear staining in squamous intraepithelial lesions was identified in air-dried smears using all of the above methods. Slides stained with avidin-biotin peroxidase and blocked with 0.3% H2O2 and phosphate buffered saline showed less background staining from neutrophils and erythrocytes compared with those without blocking. Slides stained using alkaline phosphatase antialkaline phosphatase showed excessive cytoplasmic staining of endocervical cells, making intraepithelial difficult. No nuclear staining of squamous intraepithelial lesions was observed in destained archival smears. Air-dried smears blocked with 0.3% H2O2 and phosphate buffered saline, incubated with MIB-1, and stained using avidin-biotin peroxidase gave the best results for identification of Ki-67 expression in squamous intraepithelial lesions.

Antibodies, Monoclonal↗
PubMed1995

Diagnosis of metastatic appendiceal adenocarcinoid in liver by fine-needle aspiration cytology.

A 70-yr-old woman presented with symptoms clinically attributed to acute appendicitis. An adenocarcinoid tumor of the appendix was resected, followed by right hemicolectomy with negative lymph nodes. Seven years later, a fine-needle aspiration biopsy was performed on one of multiple hepatic nodules, revealing metastatic adenocarcinoid. The cytopathologic features of the metastatic tumor are described.

Aged↗
PubMed1995

Small cell neuroendocrine carcinoma of the endometrium.

Ten cases of endometrial small cell neuroendocrine carcinoma are described. The ages of the patients ranged from 50 to 75 years (mean, 64 years). Most of the tumors were bulky, intraluminal masses that invaded at least half of the myometrial wall. Small cells were the only malignant element in two tumors. In the other eight, there were admixed elements of adenocarcinoma (five), adenosquamous carcinoma (two), or heterologous mesodermal mixed tumor (one). Histologic examination of metastatic deposits in six cases revealed solely small cells in all but one. Immunohistochemical evidence of neuroendocrine differentiation was demonstrated in all tumors using the markers chromogranin, synaptophysin, leu-7, or neuron-specific enolase. Six of these tumors were originally interpreted as mesodermal mixed tumors with a homologous, stromal-type sarcomatous component at initial pathologic examination, but were reclassified as carcinoma. Clinical follow-up of these 10 patients and an additional seven well-documented patients reported in the literature provided strong evidence for the aggressive nature of this neoplasm. Endometrial small cell neuroendocrine carcinoma is a rare, but aggressive neoplasm that can commonly be mistaken for a homologous-type mesodermal mixed tumor.

Aged↗
PubMed1994

Hepatic spindle cell tumors in HIV positive children.

Spindle cell tumors (leiomyoma, leiomyosarcoma) have been described in HIV infected children involving the gastrointestinal tract, respiratory tract and liver. The same tumor has been reported in immunocompromised children following liver and renal transplantation. A case of hepatic spindle cell tumor in an HIV infected child is discussed.

Child↗
PubMed1993

Peripartum versus idiopathic dilated cardiomyopathy in young women--a comparison of clinical, pathologic and prognostic features.

Clinicopathologic features of 13 women with peripartum cardiomyopathy were compared to 13 women aged 19 through 38 with idiopathic dilated cardiomyopathy. No presenting clinical or pathologic variable distinguished either group. However, the clinical course differed between the groups. Eleven of 13 patients with idiopathic dilated cardiomyopathy had a poor clinical outcome, defined as persistent heart failure or death. Patients in this group succumbed one year or more after disease onset. Five of 13 patients with peripartum cardiomyopathy had poor outcome, with death occurring 9 months or less after disease onset. The clinical course of peripartum cardiomyopathy appears distinct from that of idiopathic dilated cardiomyopathy in young women.

Adult↗