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Biomedical subjects

K W Barwick

Publications and source records attributed to K W Barwick.

At least 19 recordsLinked to original sources
PubMed1997

Prognostic indicators for cancer. Gastric cancer.

The recent shift in the population from patients presenting with gastric cancer to patients presenting with early-stage lesions has led to renewed interest in identifying prognostic factors for this type of tumor. Conveniently for surgeons, prognostic factors can be divided into groups that are assessed preoperatively, intraoperatively, and postoperatively. Despite the explosion of interest in genetic and molecular markers for gastric cancer, the feature best correlated with patient survival continues to be tumor stage at the time of diagnosis.

Biomarkers, Tumor↗
PubMed1993

Expression and prognostic significance of estrogen and progesterone receptors in adenocarcinoma of the uterine cervix. An immunocytochemical study.

BACKGROUND: Adenocarcinoma of the uterine cervix typically is an aggressive neoplasm with a propensity for early invasion and dissemination. Little data are available correlating histologic, histochemical, or immunocytochemical parameters with the biologic behavior of this neoplasm. Specifically, the implication of expression of estrogen and progesterone receptors in cervical adenocarcinoma is essentially undefined. METHODS: An immunocytochemical hormone receptor assay using specific monoclonal antibodies against estrogen receptors (ER) and progesterone receptors (PgR) was used to study paraffin-embedded specimens from 54 patients with primary cervical adenocarcinomas. The specimens were evaluated for heterogeneity and intensity of staining. An attempt also was made to study the relationship between the pattern of hormone receptor expression and other established prognostic indicators. RESULTS: In all patients, diffuse positive staining of benign endocervical epithelial or stromal cells was observed. Positive immunostaining was seen in the adenocarcinoma specimens of 16 of 54 (30%) patients for ER and 19 of 54 (35%) patients for PgR. Expression of ER and PgR statistically correlated with each other (P = 0.0001). Endocervical-type adenocarcinoma had the highest degree of staining for both ER and PgR. Clear cell carcinomas and intestinal-type carcinomas were negative for both receptors. Positivity for ER and PgR inversely correlated with histologic grade as defined by the International Federation of Gynecology and Obstetrics (FIGO). The relationship between hormone receptor expression and FIGO stage was not statistically significant. Survival was associated with clinical stage (P = 0.004) and with immunocytochemical status of ER expression (P = 0.032) and PgR expression (P = 0.009). CONCLUSIONS: This study of 54 specimens from patients with cervical adenocarcinoma suggests that positive expression of ER and PgR is associated with prolonged survival.

Adenocarcinoma↗
PubMed1993

Endometrial adenocarcinoma involving adenomyosis without true myometrial invasion is characterized by frequent preceding estrogen therapy, low histologic grades, and excellent prognosis.

We reviewed cases of endometrial adenocarcinoma to characterize the carcinomas that involved foci of adenomyosis in contrast to the carcinoma that invaded into the myometrium. We encountered 18 cases in which tumor involved foci of adenomyosis without myometrial invasion. There were no cancer-related deaths in these 18 cases over a minimum follow-up period of 5 years. Myometrial invasive tumor was present in 43 cases. Eight of these 43 patients died within 5 years. History of postmenopausal use of estrogen of longer than 6 months duration was obtained in 9 of the 18 patients (50%) with carcinoma confined to adenomyosis compared with 8 of the 43 (19%) with myometrial invasive carcinoma. Only 1 of the 18 cases with adenocarcinoma involving adenomyosis had architectural or nuclear grade III carcinoma compared to 12 of the 43 patients with myometrial invasive carcinoma. Adenocarcinomas involving adenomyosis were characterized by frequent preceding estrogen use, low histologic grades, and excellent prognosis.

Adenocarcinoma↗
PubMed1992

Expression of steroid hormone receptors in benign hepatic tumors. An immunocytochemical study.

Many hepatic adenomas have been demonstrated to have a clear relationship with oral contraceptive use, and it is presumed that there may be hormone receptors within the cytoplasm or nucleus of adenoma cells that mediate tumor growth in response to hormonal stimulation. Only a small number of examples of benign hepatic tumors have been analyzed for the presence of estrogen and progesterone receptors, and there has been a lack of consensus with regard to the findings. All previous studies have determined receptor levels by biochemical methods. In a retrospective study, we employed specific monoclonal antibodies against estrogen and progesterone receptors in 10 benign paraffin-embedded hepatic lesions: five examples of hepatic adenoma and five examples of focal nodular hyperplasia. All patients were female, except for one male with adenoma and one male with focal nodular hyperplasia. No patient had received tamoxifen citrate or any other form of hormonal therapy for their hepatic lesion. Positive controls included benign and malignant breast tissue. No positive staining was seen in hepatic adenoma, focal nodular hyperplasia, or normal adjacent liver parenchyma. Intense positive staining was seen in all positive control tissues. This negative result with the use of specific monoclonal antibodies in an established immunohistochemical method for analysis of estrogen and progesterone receptors does not exclude the presence of these receptors in benign hepatic lesions, but does suggest that, if present, they occur in much smaller amounts than in benign and malignant breast tissue. The presence of hormone receptors in benign hepatic tumors deserves further study.

Adult↗
PubMed1990

The effects of early treatment of hereditary tyrosinemia type I in infancy by orthotopic liver transplantation.

Two infants with hereditary tyrosinemia secondary to fumarylacetoacetate hydrolase (FAH) deficiency underwent orthotopic liver transplantation at 14 and 16 weeks of age due to poor clinical and biochemical response to medical therapy. Prompt clearance of abnormal metabolites with improved mental alertness and appetite occurred with minimal perioperative complications. Both infants tolerated rapid institution of normal diets and have shown progressive growth and development in the first 36 months after transplantation. Early liver transplantation should be considered as an option for infants with certain inherited metabolic disorders with poor prognosis, such as tyrosinemia type I, who fail to respond to medical therapy.

Amino Acid Metabolism, Inborn Errors↗
PubMed1989

Automated bibliographic retrieval based on current topics in hepatology: hepatopix.

The Hepatopix computer program helps the physician go from a computerized clinical record directly to a computerized search of the medical literature. The program uses a hierarchical list of current (key) topics in hepatology to offer "intelligent" searches. Each topic has associated "selection logic" and a tested Medline search. Starting with a liver biopsy case record, Hepatopix evaluates the selection logic to determine which topics may be pertinent to the case (based on clinical findings, lab tests, and critical words or phrases in the summary). The physician then picks those topics which are interesting enough to warrant a literature search. The citations are retrieved using search strategies stored for each topic and presented. Hepatopix is operational with over 200 topics in the realm of liver neoplasms, operating on liver biopsy case summaries from the Klatskin Database of Liver Biopsies. Besides demonstrating clinical case-directed bibliographic retrieval, it demonstrates the utility of a "key topics" list as a bridge between medical databases.

Bibliography of Medicine↗
PubMed1988

Architectural (FIGO) grading, nuclear grading, and other prognostic indicators in stage I endometrial adenocarcinoma with identification of high-risk and low-risk groups.

We studied 164 cases of Stage I endometrial adenocarcinoma to determine the relative prognostic value of International Federation of Gynecology and Obstetrics (FIGO) and nuclear grading systems. Other factors known to be of prognostic value in endometrial carcinoma also were evaluated. Both the FIGO and nuclear grading systems correlated with five-year mortality rate from cancer. Nuclear Grade 3 proved to be a superior predictor of fatal outcome (nine of 13 [69%] ) over FIGO Grade 3 (four of 13 [31%]). We advocate the combined use of FIGO and nuclear grading systems, along with other prognostic parameters, for the detection of most patients with fatal cancer.

Adenocarcinoma↗
PubMed1988

Semantic relationships and medical bibliographic retrieval: a preliminary assessment.

This paper describes a project exploring whether semantic relationships between bibliographic terms may effectively partition the clinical literature. To address this question, a set of semantic relationships was identified between pairs of bibliographic terms taken from four categories: (1) diseases, (2) treatments, (3) tests, and (4) patient characteristics. The MEDLINE system of the National Library of Medicine was used to generate lists of abstracts relating to pairs of clinical terms. Each list of abstracts was examined to identify the semantic relationships, if any, which applied to the two terms in each paper. The study suggests that semantic relationships may play a potentially valuable role in assisting computer-based medical bibliographic retrieval. The degree to which relationships partition the literature is strongly dependent on the underlying semantics of the particular bibliographic terms involved.

Information Systems↗
PubMed1988

Localization of villin, a cytoskeletal protein specific to microvilli, in human ileum and colon and in colonic neoplasms.

Villin is a cytoskeletal protein of microvilli of epithelial cell brush borders found principally in absorptive cells of the intestine and proximal renal tubule. A marker of both enterocyte differentiation and epithelial cell polarity, it has been studied mainly in experimental animals. We raised monoclonal antibodies to villin and used them to localize it in human ileum and colon and in 22 colonic neoplasms. Villin is localized in the brush border of normal ileum and in the luminal border of normal colon and is expressed with increasing staining intensity as cells migrate from crypt to surface. It was present in the luminal border in all five adenomas and in 16 of 17 adenocarcinomas studied. In addition, villin staining was observed in the cytoplasm of 10 tumors, and in the basement membrane area surrounding tumor in 10 cases. In "transitional" mucosa adjacent to carcinomas it was confined to the luminal border. Abnormal expression of villin by a significant proportion of colonic tumors suggests that it may have a role as a marker of colorectal neoplasia.

Adenocarcinoma↗
PubMed1988

Diffusely infiltrating adenocarcinoma of the endometrium. A subtype with poor prognosis.

We studied cases of stage I endometrial adenocarcinoma encountered at our institution during the period 1970-80. Five out of 164 of these tumors showed a diffusely infiltrating pattern of growth. Two of the five patients died of cancer within 5 years, with a 5-year mortality of 40%. A control group of 15 patients seen over the same period showed a 5-year mortality of 13.3%. Thus, the diffusely infiltrating pattern of growth was indicative of poor prognosis in endometrial carcinoma in stage I disease.

Adenocarcinoma↗
PubMed1988

Focal segmental ischemia of the terminal ileum mimicking Crohn's disease.

The clinical, radiographic, and pathologic features of focal segmental ischemia are similar to Crohn's disease. We report a patient with focal segmental ischemia mimicking Crohn's disease and discuss the histologic distinction between the two entities. Ischemia must be considered when "Crohn's-like" lesions are encountered in elderly patients.

Aged↗
PubMed1988

Aggressive neuroblastoma simulating Wilms tumor.

Solid intrarenal neoplasms in children are usually Wilms tumors. Occasionally, however, a neuroblastoma appears to be intrarenal. In six cases where this phenomenon was observed, the histologic findings of each tumor were identical: undifferentiated neuroblastoma. In each case the child's condition rapidly and progressively deteriorated. These six cases demonstrate the possibility that intrarenal origin or extension of neuroblastoma may be confused with Wilms tumor.

Diagnosis, Differential↗
PubMed1988

Liver disease associated with occupational exposure to the solvent dimethylformamide.

STUDY OBJECTIVE: to characterize an outbreak of liver disease among workers in a fabric coating factory; and to determine the outbreak's cause and natural history and strategies for clinical recognition, treatment, and prevention. DESIGN: clinical-epidemiological investigation. SETTING: academic medical center, Occupational Medicine Clinic, and worksite. PATIENTS: fifty-eight of sixty-six workers participated in the study. All had standard liver function tests at least once. Forty-six workers completed a questionnaire; 27 had more extensive clinical evaluation for recognized liver abnormalities. RESULTS: a plant-wide outbreak of liver disease was recognized after a new employee presented with signs and symptoms of hepatitis. Evaluation of the worksite showed that dimethylformamide, a widely used industrial solvent and known hepatotoxin, was being used to coat fabric in poorly ventilated areas without appropriate skin protection. No other major hepatotoxic exposure was identified. Overall, 36 of 58 (62%) workers tested had elevations of either aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels. Enzyme abnormalities occurred almost exclusively in production workers (35 of 46 were abnormal), whereas only 1 of 12 nonproduction workers showed any elevations in enzyme levels (P less than 0.0001). Serologic tests excluded known infectious causes of hepatitis in all but 2 workers and changes characteristic of toxic liver injury were confirmed by histologic examinations of biopsy specimens from 4 workers. The ratio of AST to ALT levels was one or less in all but 1 worker. After modification of work practices and removal of workers most severely affected from exposure, improvement in liver enzyme abnormalities and symptoms in most patients were seen, although some patients showed persistent elevations of enzyme levels. CONCLUSIONS: an outbreak of toxic liver disease has been associated with exposure to dimethylformamide in the workplace. The diagnosis of toxic liver disease was established by the clinical histories, negative viral serologies, an enzyme pattern of ALT levels being greater than AST levels, epidemiologic data on coworkers, and liver biopsy specimens. The high prevalence of unsuspected liver enzyme abnormalities in these workers suggests that occupational liver disease may occur more frequently than is generally recognized.

Adolescent↗
PubMed1987

Provocative testing for occult medullary carcinoma of the thyroid: findings in seven children with multiple endocrine neoplasia type IIa.

A rise in the serum calcitonin (CT) following provocative testing has facilitated making the diagnosis of occult medullary carcinoma of the thyroid (MCT) or C cell hyperplasia (CCH) in asymptomatic children of kindred with multiple endocrine neoplasia (MEN) type IIa. Findings were reviewed for seven children varying in age from 3 to 16 years screened at our institution between 1976 and 1986. Three had elevated basal calcitonin (S-CT). Six had significant elevation of calcitonin (delta-CT) after stimulation. Total thyroidectomy was performed in all seven. Five had MCT with bilobar involvement in three. CCH was present in all five. Two patients had no gross, microscopic, or immunohistochemical evidence of MCT or CCH. One of three had an elevated S-CT. The other had a significant delta-CT. All patients have normal postoperative S-CT and delta-CT. Our experience indicates the importance of beginning stimulation tests of affected kindred at less than 3 years of age. It appears, however, that neither elevated S-CT or positive delta-CT are perfect predictors of parafollicular cell pathology. Solitary parathyroid enlargement, second thyroid malignancy, and branchial pouch anomalies may occur with MEN IIa. One patient with MCT had a focus of papillary carcinoma. One patient with primary hyperparathyroidism had a solitary enlarged parathyroid adenoma. Additional findings were the presence of nodules of ectopic thymus in close association with the thyroid gland in three patients.

Adolescent↗
PubMed1987

The significance of intraepithelial eosinophils in the histologic diagnosis of gastroesophageal reflux.

Detection of intraepithelial eosinophils in esophageal mucosal biopsies has been suggested as histologic evidence of symptomatic gastroesophageal reflux (GER) disease in both children and adults. Previous studies have primarily examined symptomatic persons, and only one study included a comparison with normal controls. In the present study, the authors examined esophageal mucosal biopsies obtained by the hydraulic suction technic for the presence of intraepithelial eosinophils from 73 adult patients with subjective and objective evidence of GER disease and 12 asymptomatic adult volunteers in whom a series of esophageal function tests were normal. Intraepithelial eosinophils were identified in 23 (31.5%) of adult patients and in 4 (33.3%) of the asymptomatic volunteers. No clinical aspects in the GER patients correlated with the presence of eosinophils. By crude quantitation, rare eosinophils added little to more conventional assessment of histologic esophagitis and were present in one-third of normal subjects. The authors conclude that rare eosinophils in esophageal biopsies may not be a reliable criterion for the histologic assessment of GER disease.

Adult↗
PubMed1987

Hepatoblastoma presenting as isosexual precocity. The clinical importance of histologic and serologic parameters.

A 2-year-old boy presented with sexual precocity secondary to a hormone-producing hepatoblastoma. The tumor demonstrated an aggressive histologic pattern and stained immunohistochemically for alpha-fetoprotein and beta-subunit human chorionic gonadotrophin. After a successful liver transplant these tumor markers were closely followed. We conclude that histologic subclassification of hepatoblastoma is most useful for predicting likelihood of resectability. Tumors with predominantly fetal-type histology tend to be better circumscribed and are more likely to be resectable with improved survival relative to tumors with predominantly embryonal histology. The presence or absence of mesenchymal elements does not seem to have prognostic importance. Anaplastic features predict a poor outcome, but it remains for these to be uniformly defined and applied. Small uniform cellular histology with neuroblastoma-like differentiation appears to be particularly ominous. Serologic tumor markers, especially alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) are useful as monitors of potential tumor recurrence, but their efficacy is compromised by the unpredictable variation of tumor cell metabolism, undoubtedly a result of the genetic instability and heterogeneity of proliferating malignant cells.

Carcinoma, Hepatocellular↗