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Biomedical subjects

N M Walter

Publications and source records attributed to N M Walter.

18 recordsLinked to original sources
PubMed1997

Malignant peripheral nerve sheath tumour: a rare tumour and an unusual intrapericardial presentation.

A 62-year-old man presented with superior vena caval obstruction and was found to have a tumour in the pericardial cavity. This was diagnosed as a Malignant Peripheral Nerve Sheath Tumour (MPNST), an uncommon sarcoma that is exceedingly rare in this location. Stigmata of von Recklinghausen's disease were absent. Antibodies to a panel of immunoreactive markers were utilised to establish the diagnosis and exclude other tumours. The utility of such an approach in this kind of situation is briefly discussed.

Fatal Outcome↗
PubMed1996

Intraparotid facial nerve schwannoma in a child.

Neoplasms of the facial nerve presenting as a parotid mass are uncommon. In the absence of a facial palsy their origin from the nerve is usually diagnosed intraoperatively. The majority of these neurogenic neoplasms are schwannomas, with neurofibromas occurring rarely. Although the Schwann cell is the key element in both, they have distinct histopathological characteristics, and their clinical course and management often differs. The first reported case of an intraparotid facial nerve schwannoma in a child in the English literature is presented.

Child↗
PubMed1996

bcl-2 overexpression combined with p53 protein accumulation correlates with hormone-refractory prostate cancer.

Seventy-seven men with histologically proven and newly diagnosed prostate cancer we investigated for the presence of bcl-2 protein overexpression and p53 protein accumulation 1 immunohistochemistry. Forty-five men had evidence of locally advanced and metastatic disease and we treated by means of hormone manipulation. Twenty-eight patients either failed to respond to initial hormone manipulation or relapsed within 37 months from diagnosis (median 20 months). Of the 77 cancers, 37 (48% showed bcl-2 overexpression at diagnosis. Twenty-seven of those were treated with androgen ablation and 2 (74%) had hormone-refractory disease (P = 0.0128). Twenty-three of 77 men (29.8%) had nuclear staining for p53 protein. Twenty-one of those were treated with hormone manipulation and 14 (66.6%) showed hormone resistance (P = 0.0012). Seventeen patients had both bcl-2 overexpression and p53 protein accumulation, 16 of whom were hormonally treated, with 13 (81.2%) having hormone-refractory disease (P < 0.0001). These findings suggest that the combined detection of p53 protein accumulation and bcl-2 overexpression may be useful in predicting hormone resistance in prostate cancer. By deregulating programmed cell death, alteration in these genes may prevent patients from responding to androgen ablation, or allow them to escape hormonal control of the disease.

Adenocarcinoma↗
PubMed1994

Scintigraphic diagnosis of thyroid cancer. Correlation of thyroid scintigraphy and histopathology.

Scintigraphy is part of the routine examination of thyroid disease, yet there are few published reports on its utility and pitfalls. Out of 2025 consecutive thyroid examinations after excluding 230 cases of proven thyroid malignancies, 403 patients who underwent surgery were studied for histopathologic correlation. There were 232 with cold nodules, 143 with multinodular goiters (MNG) and 28 with uniformly increased uptake suggestive of toxic goiter. Malignancy was reported in 72 of the 232 cold nodules (31%). In solitary nodules, the examination was useful in selecting cases for surgery and, in cold lesions, for planning of surgery. In the majority of patients with MNG or thyrotoxicosis who were operated on, scintigraphy provided no additional information. MNG requires scintigraphy only in selected cases where there is strong suspicion of malignancy. Contrary to reports in the literature, papillary carcinoma was found to be associated with MNG in our patients.

Adolescent↗
PubMed1988

Renal failure and nephrotic syndrome associated with sulindac.

Four elderly patients developed nephrotic syndrome while receiving sulindac. Sulindac treatment had commenced 4-12 months prior to presentation with the nephrotic syndrome. Two patients also developed oliguric renal failure. Renal biopsy in one showed minimal change nephropathy and in three cases membranous nephropathy. Interstitial nephritis was present on renal biopsy in all cases. The nephrotic syndrome and renal failure resolved in all cases after withdrawal of sulindac. Two patients received steroid therapy and improvement in renal function and disappearance of proteinuria seemed to be temporarily related to steroid therapy in both cases. Despite the fact that sulindac is less likely to cause renal failure due to inhibition of renal prostaglandin secretion this report shows that sulindac treatment can be associated with renal failure and the nephrotic syndrome.

Acute Kidney Injury↗
PubMed1982

Clinical experience with the angiotensin converting enzyme inhibitor captopril.

1. Sixty-two patients (nineteen mild-moderate, forty-three severe hypertension) were treated with captopril. 2. Blood pressure was controlled long term (with/without diuretics/beta-adrenoreceptor blocking drugs) in sixteen out of nineteen patients with mild-moderate hypertension. Two patients complained of dysguesia. 3. Long term control (with/without other drugs) was achieved in thirty out of forty-three patients with severe or accelerated hypertension, many of whom had associated renal or renovascular disease. Side-effects were common: five rash, five dysguesia, two rash and dysguesia, two reversible agranulocytosis. 4. Six patients had a profound pressure fall after an initial dose of captopril 25 mg and one developed acute oliguric renal failure. Treatment should be commenced at low doses in severely hypertensive patients.

Adolescent↗
PubMed1978

Emergency treatment of severe hypertension with intravenous labetalol.

The effects of intravenously administered labetalol on blood pressure and pulse rate were examined in 17 patients with severe hypertension. Prompt and sustained falls in supine blood pressure and pulse rate occurred in ten patients (responders), but seven patients showed little or no change in either measurement (non-responders). Labetalol had a more marked effect on standing than on supine blood pressure. Only two of the responders, but all of the non-responders were concurrently receiving antihypertensive drugs. Plasma renin activity, plasma renin concentration and plasma angiotensin II concentration fell slightly over the one-hour period of observation in ten patients in whom serial measurements were made, but the changes were independent of the blood pressure response.

Adult↗
PubMed1978

A comparison between spironolactone and hydrochlorothiazide with and without alpha-methyldopa in the treatment of hypertension.

In a single blind crossover trial, spironolactone (50 mg twice a day), and hydrochlorothiazide (50 mg twice a day) were equally effective hypotensive agents in 16 patients with untreated essential hypertension. The addition of alpha-methyldopa (250 mg three times a day) to each agent produced a further significant and equal fall in blood pressure. Spironolactone therapy was assoicated with fewer clinical and biochemical side effects. The hypotensive effect of the diuretics was independent of the renin status of the patients.

Adult↗
PubMed1978

Vasoactive peptides in experimental renal hypertension.

1. Blood pressure is controlled by both integrated neurogenic and humoral vasoactive mechanisms. 2. Both vasopressor (angiotensin and vasopressin) and vasodepressor (bradykinin) hormonal peptides have been identified. 3. In acute experimental renal hypertension in the rat plasma renin, angiotensin and vasopressin have all been shown to be elevated. 4. Associated with this increase in vasopressor hormonal peptides, urinary kallikrein excretion has been demonstrated to be reduced during the development of renal hypertension. 5. The level of blood pressure achieved in experimental renal hypertension is probably a summation of these vasoactive peptides as well as other factors.

Angiotensin II↗
PubMedDate not supplied

Captopril in mild and severe hypertension.

1. Ten patients with mild essential hypertension and nine with severe treatment-resistant hypertension were treated with captopril. 2. Supine blood lpressure was controlled in 9/10 patients with mild hypertension (four with addition of propranolol). 3. There was no correlation between blood pressure fall and initial plasma renin concentration in patients with mild hypertension. 4. Captopril (plus diuretic and/or propranolol) controlled only 4/9 patients with severe hypertension. 5. Four patients developed reversible dysgeusia and one a skin rash.

Adult↗
PubMedDate not supplied

Histiocytic necrotizing lymphadenitis (Kikuchi's disease) of the cervical lymph nodes.

Histiocytic necrotizing lymphadenitis (HNL), or Kikuchi's disease, is a benign cause of lymph node enlargement of unknown origin. It may be mistaken for malignant lymphoma, both clinically and histologically. Though well recognized in the pathological literature few clinicians are aware of the disease. We present a case of cervical HNL and review the literature.

Adult↗