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Biomedical subjects

P Wasserman

Publications and source records attributed to P Wasserman.

At least 19 recordsLinked to original sources
PubMed2001

Laryngeal pyogenic granulomas do not express oestrogen or progesterone receptors.

The objective of this study was to determine the presence of oestrogen and/or progesterone receptors in laryngeal pyogenic granulomas and the impact of these receptors on recurrence of pyogenic granulomas. Twenty-two consecutive patients who underwent microlaryngoscopy and removal of pyogenic granulomas were studied retrospectively. The indications for surgery were airway compromise, failure of medical therapy and suspicion of malignancy. Twelve of these patients' granulomas were analysed for oestrogen and progesterone receptors. Charts were analysed for age, sex, location of the lesion, history of trauma, intubation or gastroesophageal reflux disease (GORD), airway symptoms and recurrence. Oestrogen/progesterone receptors were analysed following deparaffinization of specimens and immunostaining with prediluted anti-oestrogen receptor monoclonal antibody and anti-progesterone receptor monoclonal antibody. No sample expressed oestrogen or progesterone receptors. There were too few recurrences to detect if lack of these receptors played any role in determining outcome in this group. Most of the patients had a history of GORD, intubation or laryngeal surgery. There were 12 recurrences in four patients. All of the recurrences improved on prolonged courses of omeprazole. Pyogenic granulomas do not possess oestrogen or progesterone receptors and are unlikely to respond to hormonal therapy. Patients who have, or are being operated on for, laryngeal pyogenic granulomas should be placed on proton pump inhibitors to decrease the likelihood of recurrence.

Adult↗
PubMed2000

Fine-needle aspiration of granulocytic sarcomas: a morphologic and immunophenotypic study of seven cases.

Granulocytic sarcoma is an uncommon extramedullary, solid tumor of myeloid cells. Only rarely has this entity been diagnosed by fine-needle aspiration (FNA) cytology. This report encompasses the cytologic findings of FNAs from seven patients with granulocytic sarcomas, including four male and three female patients with a mean age of 52 years (range, 12 to 77 years). The aspirates were obtained from skin or subcutaneous tissue (four cases), testis (one case), posterior ileum (one case), lymph node (one case), and abdominal washing (one case). Morphology of the aspirates varied from well-differentiated to poorly differentiated cells showing little or no evidence of myeloid differentiation. Thorough search for evidence of myeloid differentiation and a high index of suspicion of granulocytic sarcoma are of paramount importance. In three cases, flow cytometric and immunocytochemical studies were applied to the FNA materials to confirm the myeloid lineage of the cells and the diagnosis. In the other four cases more than one site was involved by the tumor; once the diagnosis of granulocytic sarcoma was established with a biopsy, the FNA sufficed to confirm the diagnosis at another location. This study demonstrates that FNA cytology in conjunction with appropriate immunophenotyping can provide an accurate diagnosis of granulocytic sarcoma. Fine-needle aspiration can reduce the need for surgical intervention when combined with immunophenotypic studies and when additional anatomic sites are involved.

Adolescent↗
PubMed2000

Intralingual dermoid cysts: a report of two new cases.

Dermoid cysts of the oral cavity are rare. When they do occur, the most common site is the floor of the mouth. Intralingual dermoid cysts are even more rare, and until now, there were only 15 such reports in the English-language literature. In this article, we describe two additional cases. Magnetic resonance imaging is extremely helpful in establishing a differential diagnosis. Surgical excision is recommended to correct deglutition and speech problems. Its rarity notwithstanding, dermoid cyst should be considered in the differential diagnosis of tongue masses in the younger population.

Adolescent↗
PubMed1998

Osteosarcoma of the larynx.

About 11,600 cases of laryngeal cancer were reported in the United States in 1995, accounting for 1% of all reported cancers. Fewer than 1% of laryngeal cancers are sarcomas, osteosarcoma being the rarest type. Twelve cases of laryngeal osteosarcoma have been cited in the literature. A 47-year-old man presented with hoarseness following a benign vocal polypectomy. The entire larynx appeared swollen, although both vocal folds moved well. Biopsies did not reveal pathologic tissue. Computed tomographic imaging revealed a destructive, expansile lesion of the thyroid cartilage. A computed tomography-guided biopsy of this cartilage revealed a high-grade sarcoma. Laryngeal osteosarcoma was diagnosed following total laryngectomy. Laryngeal osteosarcoma is a highly malignant neoplasm with early hematogenous spread. Survival statistics for peripheral osteosarcoma are poor. Limited experience reveals that a combination of surgery and radiotherapy with adjuvant chemotherapy can offer some palliation. The literature and published cases of laryngeal osteosarcoma are reviewed.

Combined Modality Therapy↗
PubMed1998

The "deroofing" of Schlemm's canal in patients with open-angle glaucoma through placement of a collagen drainage device.

BACKGROUND AND OBJECTIVES: A preliminary study was conducted to examine a new surgical approach for the management of patients with open-angle glaucoma in which Schlemm's canal is opened to restore drainage in a nonpenetrating fashion. The authors compared the results of the surgical procedure including the new glaucoma drainage device with the results of standard trabeculectomy. PATIENTS AND METHODS: The authors performed a new type of surgical procedure on 58 consecutive patients with open-angle glaucoma. The procedure entails "deroofing" Schlemm's canal to facilitate the drainage of aqueous without penetrating the eye. This is done by exposing the canal after a partial-thickness sclerectomy and keratectomy along a 5-mm arc. After the canal was deroofed, a new type of collagen glaucoma drainage device was placed in the surgical site to maintain drainage postoperatively. Patient data, including intraocular pressure (IOP), complications, and the number of medications required to maintain adequate pressures, were analyzed for 1 year postoperatively. RESULTS: Within 1 to 2 months postoperatively, 80.9% of the patients achieved an IOP lower than 21 mm Hg. This improved to 88.9% at 3 to 6 months postoperatively and 87.5% at 6 to 12 months postoperatively. The only major complications were microperforations (8.6%) related to surgical technique and a few cases of high IOP that required repeat operations (10.3%). CONCLUSIONS: The nonpenetrating technique for deroofing the canal effectively allows the drainage of aqueous to acceptable levels (in the range of 15 to 17 mm Hg) without the complications associated with penetrating trabeculectomy. Complications are rare, and the collagen drainage device appears to be effective for allowing the drainage site to remain patent after its dissolution.

Adult↗
PubMed1996

Retrospective study of the correlation between the DNA repair protein alkyltransferase and survival of brain tumor patients treated with carmustine.

We tested the hypothesis that the level of the DNA repair protein O6-alkylguanine-DNA alkyltransferase in brain tumors was correlated with resistance to carmustine (BCNU) chemotherapy. Alkyltransferase levels in individual cells in sections from 167 primary brain tumors treated with BCNU were quantitated with an immunofluorescence assay using monoclonal antibodies against human alkyltransferase. Patients with high levels of alkyltransferase had shorter time to treatment failure (P = 0.05) and death (P = 0.004) and a death rate 1.7 times greater than patients with low alkyltransferase levels. Furthermore, the size of the subpopulation of cells with high levels of alkyltransferase was correlated directly with drug resistance. For all tumors the variables most closely correlated with survival, in order of importance, were age, tumor grade, and alkyltransferase levels. For glioblastoma multiforme, survival was more strongly correlated with alkyltransferase levels than with age. These results should encourage prospective studies to evaluate alkyltransferase levels as a method, for identifying brain tumor patients with the best likelihood of response to BCNU chemotherapy.

Antibodies, Monoclonal↗
PubMed1996

Intracellular Localization and intercellular heterogeneity of the human DNA repair protein O(6)-methylguanine-DNA methyltransferase.

O(6)-Methylguanine-DNA methyltransferase (MGMT) is a DNA repair protein that removes alkyl adducts from DNA and may be important in tumor resistance to alkylation chemotherapy. MGMT was visualized in human cells and tumor tissues with monoclonal antibodies against MGMT and immunofluorescence microscopy, and fluorescent signals were quantified by digital image analysis. MGMT was found both in the cytoplasm and the nucleus, and in either locale the protein reacts with alkylated DNA bases and becomes inactivated and lost from the cell. Cell lines in culture and xenografts showed a broad normal distribution of nuclear MGMT levels, but human brain tumors often showed a skewed distribution, with a significant fraction of cells with high levels of MGMT. O(6)-Benzylguanine, a suicide substrate inactivator for MGMT activity, reduced MGMT in human cells and in a mouse xenograft to levels undetectable by antibody assay 1 h post-treatment. In melanoma specimens taken from a patient 3 h post-treatment with temozolomide, MGMT levels were reduced by 70%. This quantitative immunofluorescence assay can be used to monitor MGMT and it depletion in human tumors to improve the use of alkylating agents in cancer chemotherapy.

Animals↗
PubMed1995

O6-methylguanine-DNA methyltransferase in human brain tumors detected by activity assay and monoclonal antibodies.

O6-methylguanine-DNA methyltransferase (MGMT) activity was measured in 68 tissue samples taken from brain. A wide range in activity among samples was observed, with all nonmalignant samples showing transferase activity (Mer+) but approximately 15% of WHO grade II low-grade astrocytomas and WHO grade IV glioblastoma multiformes lacking activity (Mer-). On average, astrocytomas and glioblastomas showed less transferase activity than either nonmalignant tissue or meningiomas. Monoclonal antibodies specific for MGMT showed both cytoplasmic and nuclear staining of Mer+ brain tumor cells in culture but no staining of Mer- cells in culture. In pathology specimens from anaplastic astrocytomas, glioblastoma multiformes, and meningiomas, antibody staining revealed both cytoplasmic and nuclear MGMT, while one sample showed little or no MGMT-specific staining. These results help explain why nitrosoureas have been among the most successful agents in treatment of brain tumors and indicate the subcellular localization for the repair activity, which may be relevant to nitrosourea resistance.

Antibodies, Monoclonal↗
PubMed1995

Histopathological and cytopathological correlations of percutaneous testis biopsy and open testis biopsy in infertile men.

A testis biopsy is used to assess quantitatively testicular spermatogenesis in infertile patients. Recently, several reports have used less invasive, percutaneous methods to obtain testis tissue. Percutaneous testis biopsies and touch imprints, immediately followed by open testis biopsies, were performed on 24 testes (19 patients) to ascertain whether they could provide the same histological information as an open biopsy. The technique of percutaneous testis biopsy using a core biopsy system is described. Comparison of the percutaneous and open biopsy histological diagnoses revealed a 95% correlation. The percutaneous method using 1 pass through the testis failed to provide adequate tissue in 2 of 24 patients. Touch imprints obtained by the percutaneous method also provided a 95% correlation compared with the open method (2 of 24 touch imprints were lost during processing and, thus, were not evaluated). Percutaneous testis biopsies and touch imprints provide adequate tissue for histological and cytological evaluation, with excellent correlation with biopsies obtained by the traditional open methods. Percutaneous testis biopsy and touch imprint may be performed in an office setting, thus obviating the need to perform an open biopsy in the operating room.

Adult↗
PubMed1994

O6-methylguanine-DNA methyltransferase in normal and malignant tissue of the breast.

An important component of high-dose chemotherapy/autologous bone marrow support regimens for adjuvant treatment of breast cancer is carmustine. Preclinical studies have shown that the level of the DNA repair protein O6-methylguanine-DNA methyltransferase is correlated with the resistance of cultured human tumor cells to this drug, but little is known about transferase levels of breast tissue in vivo. We measured the DNA repair activity in 80 tissue samples from 65 patients, including normal, abnormal, benign, and malignant specimens. Wide interindividual variations was observed and average transferase levels were similar in normal and benign tissue. However, transferase levels were significantly elevated in stage I-IV disease. In addition, the frequency of samples with no detectable transferase was greatly reduced in this malignant group, and transferase was positively correlated with the presence of positive nodes, a marker for disease progression. In contrast, transferase levels were not correlated with age or estrogen receptor status, and the levels in normal tissue did not vary between patients with benign or malignant disease. These results suggest that this DNA repair activity may be increased in breast cancer relative to normal tissue and encourage further study of the predictive value of transferase measurements in high-dose chemotherapy/autologous bone marrow transplant for breast cancer.

Adult↗
PubMed1981

Changes in sizes and distensibility of the aging kidney.

Age-related changes in kidney size and distensibility were examined in 103 patients aged 18 to 89 years without evidence of renal disease or hypertension. Kidney dimensions were measured on radiographs obtained 30 s and 5 min after intravenous injection of contrast agent. Kidney distension was calculated by expressing the difference in area between 30 s and 5 min films as a percentage of the area at 30 s. Distension was not significantly correlated with age but wide variation between individuals may limit the value of measurement of this change in size as a diagnostic test. After middle age, kidney length diminished by approximately 0.5 cm per decade. This reduction implies a loss of kidney weight about double that recorded at necropsy. Post-mortem evidence probably underestimates differences between age groups and age-related diminution in kidney size may be greater than post-mortem evidence suggests.

Adolescent↗
PubMed1979

Presplenectomy transcatheter occlusion of the splenic artery.

Transcatheter splenic artery occlusion can be performed rapidly and safely prior to splenectomy. This procedure reduces splenic bulk and decreases intraoperative bleeding. Patients not operated on after transcatheter splenic artery occlusion have had high mortality, and therefore the procedure should probably not be considered unless splenectomy is contemplated. An illustrative case is reported.

Adult↗
PubMedDate not supplied

Parathyroid cyst: current diagnostic and management principles.

BACKGROUND: Parathyroid (PTH) cyst is a rare lesion. Only about 200 cases have been reported to date. The diagnosis of a PTH cyst is difficult, particularly in its differentiation from thyroid cyst. It has clinical significance because PTH cysts can mimic a thyroid mass and can be associated with hyperparathyroidism. METHODS: This presentation illustrates an additional case of a PTH cyst. The importance of fine-needle aspiration (FNA) in the diagnosis of PTH cyst and its management are discussed. RESULTS: Fine-needle aspiration of clear fluid containing an elevated PTH hormone level proved to be diagnostic in the patient. Recurrence of the cyst after FNA required surgical resection. The current concepts of etiology and treatment are summarized. CONCLUSIONS: PTH cyst should be in the differential diagnosis in any patient initially seen with an anterior cystic neck mass. Radiologic imaging and FNA can accurately diagnose PTH cysts. Surgical excision may be needed for recurrent cysts after aspiration.

Adult↗
PubMedDate not supplied

Metastatic pulmonary artery sarcoma. Report of a case with diagnosis by fine needle aspiration.

BACKGROUND: Primary pulmonary artery sarcomas (PPASs) are uncommon neoplasms with a poor prognosis. They often present with symptoms of pulmonary thromboembolus. They may be locally aggressive and give rise to embolic pulmonary metastases. Extrathoracic metastases are uncommon. They are usually diagnosed late in the course of the disease or at autopsy. Radiographic studies alone are insufficient to definitively diagnose PPAS. CASE: A 68-year-old female presented with symptoms consistent with pulmonary thromboemboli. Computed tomography of the chest with intravenous contrast revealed an intraluminal filling defect involving the left main pulmonary artery. Despite anticoagulation therapy, the symptoms persisted. Four months after the initial presentation, the patient developed multiple nodules in the left lung. Fine needle aspiration (FNA) of one of the nodules showed loosely cohesive clusters of pleomorphic and spindle-shaped malignant cells and isolated ones. These cells were embedded in extracellular, metachromatic material. They were vimentin positive and keratin negative. There was no evidence of extrapulmonary disease. A diagnosis of metastatic pulmonary artery sarcoma was made and confirmed on histology. Three weeks following the pneumonectomy, the patient died of postoperative complications. CONCLUSION: Patients with PPAS often present with symptoms of atypical or nonresolving pulmonary thromboemboli. The interval between presentation and definitive diagnosis is usually delayed and probably affects the prognosis. The timely use of FNA techniques could result in an earlier diagnosis, possibly improving outcome.

Aged↗