Biomedical subjects
Publications and source records attributed to M E Herd.
Schwannomas of the nasal cavity and paranasal sinuses are very rare. We report the case of a 54-year-old woman with a schwannoma arising from the nasal septum. We discuss the clinical presentation, differential diagnosis, imaging characteristics and treatment of this rarely encountered lesion.
Explore the source record for details and available documents.
One hundred retrospective appendectomy specimens were examined in an attempt to study the degree of uniformity and clarity of reporting of this common surgical specimen. There was full agreement in 73 cases and some degree of discrepancy in 27 cases. It is suggested that greater clarity in reporting can be achieved with five reporting categories: (i) established acute inflammation; (ii) no evidence of acute inflammation ("normal"); (iii) features suggestive of early inflammation; (iv) peri-appendicitis; (v) other features, such as granulomata, Enterobius vermicularis, tumours, etc.
To determine the prognostic importance of microscopic rectal inflammation we followed up 82 patients (aged 21 to 78 years, 44 men) with chronic quiescent ulcerative colitis over 12 months. At trial entry each patient underwent a rectal biopsy and sections were graded independently by two histopathologists. A chronic inflammatory cell infiltrate of varying severity was present in all biopsy specimens, and 58% had crypt architectural irregularities. In addition, 32% had evidence of acute inflammatory activity: 28% acute inflammatory cell infiltrate, 11% crypt abscesses, and 22% mucin depletion. Agreement between the two histopathologists for the presence of each of these features was 94% (90-98%). During the 12 month follow up 27 patients (33%) relapsed after a mean interval of 18 weeks (range 3-44 weeks). Relapse rates were unrelated to duration or extent of disease or to the type of maintenance drug treatment. In patients with an acute inflammatory cell infiltrate 52% relapsed, whereas in the absence of such an infiltrate only 25% relapsed (p = 0.02). Similarly, relapse rates were higher in the presence of crypt abscesses (78% v 27%, p less than 0.005), mucin depletion (56% v p less than 0.02), and breaches in the surface epithelium (75% v 31%, p = 0.1). The presence of a chronic inflammatory cell infiltrate or crypt architectural irregularities, however, bore no relation to the frequency of colitis relapse.
To assess the safety and efficacy of delayed-release mesalazine (5-aminosalicylic acid) as maintenance treatment for patients with ulcerative colitis, 100 patients with quiescent colitis were randomly grouped to receive either delayed-release mesalazine or an equivalent dose of enteric-coated sulfasalazine in a 48-wk trial. Groups were comparable for age, sex, and duration and extent of disease. Relapse rates at 48 wk were as follows: sulfasalazine 38.6% (95% confidence limits, 24%-54%) and mesalazine 37.5% (95% confidence limits, 24%-53%), chi 2 = 0.01, p greater than 0.90. Mean time to relapse, cumulative relapse rate, and relapse severity were similar in the two groups. Headaches and upper gastrointestinal symptoms--common at trial entry--improved to a greater extent in patients receiving mesalazine. Delayed-release mesalazine is an effective treatment for maintaining ulcerative colitis remission and is associated with fewer side effects than equivalent doses of enteric-coated sulfasalazine.
Oral formulations of 5-aminosalicylic acid (mesalazine) appear less toxic than sulphasalazine. We have therefore compared sulphasalazine, low dose mesalazine and high dose mesalazine in the treatment of mild to moderate relapse of ulcerative colitis. Sixty one patients (32 men, aged 20-78 years) were randomly allocated to sulphasalazine 2 g daily, mesalazine 800 mg daily, or mesalazine 2.4 g daily in a double blind, double dummy, four week trial. Groups were comparable for age, sex, extent of disease, and pretrial sulphasalazine intake. Four patients were unable to complete the study because of treatment failure (two taking sulphasalazine and two high dose mesalazine). A further two patients taking sulphasalazine developed side effects necessitating withdrawal. Within treatment comparisons revealed significant improvement of: sigmoidoscopic grade in the sulphasalazine group; rectal bleeding, sigmoidoscopic and histological grade in the low dose mesalazine group; stool frequency, rectal bleeding and sigmoidoscopic grade in the high dose mesalazine group. Greater improvement in rectal bleeding (p less than 0.05) and sigmoidoscopic appearances (p less than 0.05) occurred in patients taking high dose mesalazine than in those taking sulphasalazine. In two patients taking high dose mesalazine minor rises of plasma creatinine concentrations occurred, suggesting the need to monitor renal function.
Scanning electron microscopy (SEM) was used to compare the topographic fine structure of urothelium from normal, neoplastic and inflamed human bladders. The three groups of patients show different patterns. The normal bladder lining is characterized by regularly arranged large superficial cells with ridged surfaces. By contrast, the surface cells of a transitional cell carcinoma are rounded up and covered with microvilli. In some patients with cystitis or post inflammatory hyperplasia SEM appearances intermediate between normal and neoplastic patterns are encountered. However, except in extremely severe cystitis it is possible on SEM to differentiate between inflamed and neoplastic urothelium. Surface microvilli provide a useful malignant marker for transitional cell carcinoma. However, severe inflammation of the bladder, when diagnosed on cystoscopic examination, can and must be excluded by light microscopy before this marker is considered diagnostic for neoplasia.
Biopsies of healthy looking urothelium from 61 patients with transitional cell carcinoma (TCC) of bladder were examined by scanning electron microscopy (SEM) and light microscopy. A proportion (40%) showed abnormal features on SEM, in particular pleomorphic microvilli (PMV) in at least one area. SEM appearances were graded into four categories depending upon divergence from normal. Patients were followed up at cystoscopy and one year later a strong correlation was noted between original abnormal SEM appearances and subsequent tumour recurrence. These early results suggest that SEM could be helpful in the diagnosis, assessment, and clinical management of the unstable urothelium.
Seventeen placentae from second trimester abortions induced by the injection of extra-amniotic prostaglandin have been examined. The extraplacental membranes, the chorionic plate of the placenta, the placental intervillous space and the placental villi were normal in all cases. In all but one specimen lesions were, however, noted in the decidua, these including focal decidual necrosis, intradecidual haemorrhage, thrombosis of maternal vessels and dilatation and congestion of the maternal vasculature. Similar decidual lesions were also seen in placentae from spontaneous and surgical second trimester abortions and it is concluded that prostaglandins do not produce any specific lesions in the placenta or decidua. It is suggested that the negative findings of this study indicate that prostaglandins do not induce abortion by either direct injury to the placenta or by provoking utero-placental ischaemia.