Biomedical subjects
Publications and source records attributed to K M Kerr.
Pancoast syndrome, which comprises a lower brachial plexus lesion and Horner's syndrome, usually results from local invasion beyond the confines of the lung by an apical lung carcinoma. Other causes are rare. We report the unusual occurrence of a case of Pancoast syndrome caused by a destructive sclerosing fibrosis after pulmonary Staphylococcus aureus infection.
BACKGROUND: A distinctive cytologically atypical lesion has been found in patients with primary adenocarcinoma of the lung. The aim of this study was to characterise the lesion and assess its role in tumour pathogenesis. METHODS: Lung parenchyma from 175 consecutive resection specimens for primary pulmonary adenocarcinoma were examined. Foci of atypical hyperplasia were identified. Cell proliferation state and expression of S100 and carcinoembryonic antigens were evaluated by immunohistochemistry. Clinical data on cigarette smoking and occupational exposure to carcinogens were abstracted from inpatient case notes. RESULTS: Ten cases (5.7%) with these distinctive cytologically atypical lesions were identified. The lesions showed immunohistochemical evidence of increased cell proliferation and focal carcinoembryonic antigen expression. The associated adenocarcinomas were of peripheral (parenchymal) type. There was an association with cigarette smoking and two of the 10 patients had synchronous carcinomas elsewhere in the lung. CONCLUSION: The clinical and pathological associations of these lesions suggest that they may be important in the histogenesis of primary pulmonary adenocarcinoma.
BACKGROUND: The use of computed tomography in mediastinal staging of lung cancer relies on the premiss that malignant lymph nodes are larger than benign ones. This hypothesis was tested by linking node size and presence or absence of malignancy and looking at factors possibly influencing the size of benign nodes. METHODS: All accessible mediastinal lymph nodes were taken from 56 consecutive patients with lung cancer who underwent thoracotomy. Nodes were measured and histologically examined. Resected cancer bearing lung from 44 of these patients was assessed for degree of acute and chronic inflammation. RESULTS: Lymph node size was not significantly related to the presence of metastatic disease, 58% of malignant and 43% of benign lymph nodes measuring over 15 mm. Similarly, there was no statistically significant relation between size of lymph nodes and the likelihood of malignancy, 20% of lymph nodes of 10 mm or more but also 15% of those less than 10 mm being malignant. Thresholds of 15 and 20 mm showed similar results. The maximum size of benign lymph nodes was significantly greater in those patients with histological evidence of acute pulmonary inflammation than in those without. CONCLUSIONS: The study shows that in patients with lung cancer (1) malignant mediastinal lymph nodes are not larger than benign nodes; (2) small mediastinal lymph nodes are not infrequently malignant; and (3) benign adenopathy is more common in patients with acute pulmonary inflammation.
BACKGROUND: Pleural aspiration with pleural biopsy is advised for the investigation of pleural effusion. The clinical investigation of pleural effusion in a group of teaching hospitals was audited with reference to adequacy and diagnostic value of sampling procedures. METHODS: A retrospective review of case records of all patients investigated for pleural effusion during an eight month period was performed. The records of 112 patients, age range 16-91 years, who underwent 150 procedures were reviewed. RESULTS: Microbiology samples were obtained from 137 procedures, of which five provided a positive culture, including one for mycobacteria. Cytology samples were obtained from 145 procedures though approximately two thirds of samples were less than the recommended 30 ml. The pleural biopsy rate was 30%, varying from 0% in general or thoracic surgery to 68% in thoracic medicine (thoracic surgeons carried out thoracoscopy). Twenty nine per cent of pleural biopsy samples were of poor quality. The complication rate was 2% for aspiration alone, and 4% for aspiration plus biopsy. The sensitivity of the first diagnostic procedure for a diagnosis of malignancy or tuberculosis was 53% for cytology alone, 50% for biopsy alone and 72% for cytology plus biopsy. CONCLUSION: The samples obtained from pleural aspiration and biopsy in the initial investigation of pleural effusion are often inadequate. Further education is necessary to improve the quantity and quality of specimens submitted for histological and cytological examination.
The introduction of new GP contracts in April 1990 incorporated a financial incentive to undertake minor surgical procedures. Previous reports have noted large increases in the number of GP-derived skin specimens after April 1990. Our present study intended to address whether similar changes have occurred in Grampian Region as well as, more specifically, noting whether there have been changes in the quality of practice following the 1st April 1990. A retrospective study of skin biopsies removed by general practitioners in Grampian Region was undertaken. Cases were selected from four periods of six months (1st April to end of September) in 1987, 1988, 1989 and 1990. All skin specimens sent by general practitioners to the Department of Pathology, Aberdeen Royal Infirmary, were included. Following April 1990 there was a two-fold increase in skin specimen numbers--an increase significantly greater than increases observed over previous years (p < 0.01). Of particular note was the contribution made to this increase by Aberdeen City GPs whose contribution rose five-fold (p < 0.0001). Non-benign lesions (ie malignant plus carcinoma-in-situ-) represented 6% of lesions excised. A non-benign clinical diagnosis or an indication of suspicion was written on only one third of request forms for histopathologically diagnosed non-benign lesions. The proportion of histologically incompletely excised lesions rose over the four years (p < 0.01); moreover the increase in total numbers of lesions resulted in a striking increase in the actual numbers of incompletely excised lesions after April 1990.
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A small group of stonemasons working with sandstone was exposed to levels of respirable quartz up to 130 times the workplace standard over a period of up to 6 years. Two died of accelerated silicosis, a disease that caused serious diagnostic difficulties and was initially not recognised by the doctors of the then Department of Health and Social Security Medical Boarding Centre (respiratory diseases). Previous descriptions of this disease in the UK date back to the years of the industrial revolution (late 18th century). One other mason on the site proved to have an earlier stage of accelerated silicosis and two had radiographic changes of early classic silicosis. Regulations intended to prevent silicosis have been in place in the UK for many decades and were strengthened by the Health and Safety at Work Act in 1974. Although the workers had been aware of a health risk from quartz, they had not been able to persuade management to take effective preventive action until serious illness had occurred. Current pressures on management to cut overheads and to achieve maximum productivity could, as in this instance, lead to neglect of health and safety standards.
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Acute bronchial damage was caused by aspiration of a ferrous sulphate tablet, early histological changes (unlike in the few previously reported cases) being observed in the biopsy specimens.
Twenty-five patients with histologically proven small cell lung cancer who were in too poor physical condition to receive 'aggressive' chemotherapy were treated with vindesine and etoposide (VE). The median survival was 195 days, and there were 4 survivors of greater than 460 days. Eight patients died before the second pulse of chemotherapy, and these all had a Karnofsky score of less than or equal to 20 at diagnosis. Toxicity of the chemotherapy regimen was minimal, and the results suggest that VE chemotherapy may be suitable for the treatment of patients with small cell lung cancer who are unsuitable for more toxic chemotherapy.
Tissue specimens from 15 patients with endobronchial papillary squamous tumours were probed for the presence of human papillomavirus DNA using the technique of in situ hybridization with probes to human papillomavirus genotypes 4, 5, 6b, 8, 11, 16 and 18. Despite the histological similarity of these lesions to known human papillomavirus-associated tumours no evidence of hybridization was detected in any of the cases analysed. It is thus unlikely that human papillomavirus has a significant role in the genesis of these tumours.
Sixty patients with histologically proven lung cancer who had been accepted for mediastinoscopy or thoracotomy were prospectively entered into a study to evaluate computed tomographic (CT) scanning, 57Co-bleomycin scanning, and barium swallow in preoperative assessment of mediastinal lymph node metastasis. Fifty-six patients had thoracotomy at which all accessible lymph nodes were sampled. Twenty-four patients were found to have mediastinal tumor on histologic analysis of the resected mediastinal lymph nodes. Neither 57Co-bleomycin scanning nor barium swallow were clinically useful, with sensitivities of 21 percent and 11 percent respectively, whereas CT scanning was helpful. However, there was no clear cutoff point of node size to optimize sensitivity and specificity for CT scanning. When nodes greater than or equal to 15 mm were taken to indicate likely malignancy, the sensitivity was 58 percent and the specificity was 87 percent and when greater than or equal to 10 mm was used the sensitivity was 80 percent but the specificity was only 55 percent. There was no clear relationship between the size of the largest resected lymph node in each patient and the presence of malignant lymph nodes. Only 42 percent of patients with resected nodes greater than or equal to 2 cm had histologic evidence of metastases. We conclude that CT scanning should be used to indicate the presence and site of mediastinal lymph nodes, which, when visualized, should always be sampled and histologically examined prior to resection of primary tumor.
We report the case of an 83-year-old man who developed primary rhabdomyosarcoma of the urinary bladder 18 years after having a squamous carcinoma of the bladder treated with interstitial radiotherapy. The literature on adult urinary bladder rhabdomyosarcoma and radiation induced rhabdomyosarcoma is reviewed.
Spores of Aspergillus fumigatus can interfere with certain aspects of phagocytic cell function. In this study we have looked at the ability of human pulmonary macrophages to bind and kill spores of A. fumigatus which have been opsonized in untreated and heat-treated serum. For comparison, the non-pathogenic fungus Penicillium ochrochloron has been used. More than 60% of spores of both fungal species became cell-associated with the macrophages following incubation at 37 degrees C for 1 h. Spores of A. fumigatus opsonized in 5% pooled normal serum were significantly more resistant to killing by pulmonary macrophages than similarly opsonized spores of P. ochrochloron (p less than 0.02). However, serum which had been heated to 56 degrees C for 30 min prior to opsonization significantly increased (by approximately 80%) the ability of pulmonary macrophages to kill spores of A. fumigatus when compared with untreated sera (p less than 0.001). No such difference occurred with spores of P. ochrochloron. These unexpected observations fit with the known propensity of A. fumigatus to colonize the airways of patients with asthma and cystic fibrosis, conditions in which a protein-rich bronchial exudate characteristically occurs. Moreover, the presence of such a protective mechanism in a soil organism strongly suggests that complement-like substances may also play a role in protozoal phagocytosis. This is an area of research that does not appear to have been investigated.
Atypical carcinoid tumors of the bronchial tree are uncommon. Their tendency to metastasize is well recognized, characteristically producing osteoblastic bone deposits without disturbance of calcium homeostasis. We report two patients who presented with hypercalcemia and osteolytic bone metastases following surgical removal of atypical bronchial carcinoid tumors. In one of the patients, chemotherapy induced remission and controlled the hypercalcemia.
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A series of 46 primary bronchogenic carcinomas for which thymidine labelling index (%TLI) (in all cases) and tumour doubling time (DTact) (in 13 cases) had previously been measured were followed up for 5 years and these data compared with length of post operative survival, tumour volume at operation and pathological staging. We found no correlation between reduced survival and higher tumour %TLI, indeed the reverse may be true. Larger tumours tended to have higher labelling indices considering either primary tumour volume or 'T'-category. Five year survivors had smaller tumours, tended to have T1 tumours and Stage I disease but did not have significantly lower tumour %TLIs. No relationship was found between DTact and any other parameter.