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Biomedical subjects

R Jaffe

Publications and source records attributed to R Jaffe.

At least 73 records · Page 4Linked to original sources

The histopathology of Langerhans cell histiocytosis.

Selected aspects of the histopathology of Langerhans cell histiocytosis representing diagnostic difficulty and/or controversy are presented with emphasis on the composition of pathological lesions. Lesional cell phenotypes and the factors influencing variations are noted. Features of several skin-based histiocytic disorders, dermatopathic lymphadenopathy and Rosai-Dorfman disease are compared. Associations between Langerhans cell histiocytosis and juvenile xanthogranuloma and malignant disorders are considered. Observations of potential significance in the eventual elucidation of the pathogenesis of these enigmatic diseases are presented.

Antigens, CD↗

The normal Langerhans cell and the LCH cell.

The epidermal Langerhans cell is the bone marrow-derived dendritic, antigen-presenting cell of the skin. It is characterised by a unique intracytoplasmic organelle--the Birbeck granule--and constitutively expresses class II MHC molecules and the CD1a glycoprotein. The Langerhans cell represents one of the most potent antigen-presenting cells of the body, and fulfils an important role in detecting foreign antigen entering the body through the skin and in immune surveillance. The distribution of Langerhans cells is restricted to the skin, lymph nodes, bronchial mucosa and thymus. The discovery by Nézelof in 1973 that the lesional cells in the disease then called 'Histiocytosis X' contained Birbeck granules established the close relationship between the Langerhans cell and this disease and led ultimately to the adoption of the name Langerhans cell histiocytosis to replace the older term. The LCH cell expresses the phenotype of a Langerhans cell apparently 'fixed' at an early stage of cell activation. The LCH cell is, however, functionally defective in antigen presentation, and the tissue distribution of the disease--affecting bone, skin, lymph node, lung, liver, spleen, CNS, gastro-intestinal tract and bone marrow--is quite different from the normal distribution of the Langerhans cell. Studies are now under way throughout the world to investigate the relationship between the normal Langerhans cell and the LCH cell. Specifically we need to identify whether the LCH cell is a cell arrested at a specific time in normal Langerhans cell ontogeny or if it represents a response to a biological insult to the mature Langerhans cell or its precursors.

Antigen-Presenting Cells↗

Sudden unexpected death in childhood due to unsuspected diabetes mellitus.

We report the case of an otherwise healthy 11-year-old girl who died suddenly of previously undiagnosed diabetes mellitus type I, following a 2-day minor upper respiratory infection. Insulin dependent diabetes mellitus (IDDM) is a rare cause of sudden death of apparently healthy children. This report demonstrates a recommended diagnostic pathway for IDDM from the substantiation of vesicular fatty liver to specific pancreatic histological and histochemical changes.

Child↗

The cardiovascular sparing effect of fentanyl and atropine, administered to enflurane anesthetized dogs.

Cardiovascular effects of high dose opioid together with low dose inhalant were compared with inhalant alone to determine whether opioid/inhalant techniques were less depressant on the cardiovascular system. The effects of positive pressure ventilation and increasing heart rate to a more physiological level were also studied. Cardiovascular measurements recorded during administration of enflurane at 1.3 minimum alveolar concentration (MAC; 2.89 +/- 0.02%) to spontaneously breathing dogs (time 1) and during controlled ventilation [arterial carbon dioxide tension at 40 +/- 3 mmHg (time 2)] were similar. At time 2, mixed venous oxygen tension and arterial and mixed venous carbon dioxide tensions were significantly decreased, while arterial and mixed venous pH were significantly increased compared to measurements at time 1. After administration of fentanyl to achieve plasma fentanyl concentration of 71.7 +/- 14.4 ng/mL and reduction of enflurane concentration to yield 1.3 MAC multiple (0.99 +/- 0.01%), heart rate significantly decreased, while mean arterial pressure, central venous pressure, stroke index, and systemic vascular resistance index increased compared to measurements taken at times 1 and 2. Pulmonary arterial occlusion pressure was significantly increased compared to measurements taken at time 2. After administration of atropine until heart rate was 93 +/- 5 beats/min (plasma fentanyl concentration 64.5 +/- 13.5 ng/mL) heart rate, mean arterial pressure, cardiac index, oxygen delivery index, and venous admixture increased significantly compared to values obtained at all other times.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

Detection of cytomegalovirus in formalin-fixed paraffin-embedded donor, native and allograft liver tissue using a multiplex polymerase chain reaction-liquid hybridization assay.

A multiplex polymerase chain reaction (PCR)-liquid hybridization assay detecting a minimum 10 fg of cytomegaloviral (CMV) DNA has been developed. This assay successfully detected viral nucleic acids in 25/26 (96.2%) routinely embedded allograft liver biopsies with CMV hepatitis. No CMV DNA was detected in 15 native and 12 donor liver tissues sampled at the time of liver transplantation. These results indicate that archived formalin-fixed, paraffin-embedded liver tissues obtained from patients with significant liver disease can be successfully analyzed for CMV by PCR, retrospectively. Failure to detect CMV in native and donor livers implies that any latent virus present within these tissues is very focally distributed, or is below the threshold of detection applicable to PCR.

Base Sequence↗

Granulomatous hepatitis in three children due to cat-scratch disease without peripheral adenopathy. An unrecognized cause of fever of unknown origin.

OBJECTIVE: To report the clinical experience of three patients with fever of unknown origin ultimately diagnosed as having cat-scratch granulomatous hepatitis in the absence of peripheral adenopathy. DESIGN: Case-control study. SETTING: Referral center at university-based referral practice. PATIENTS: Three children with fever of unknown origin. Follow-up following presentation was 6 months for each patient. MEASUREMENT AND RESULTS: All three patients with fever of unknown origin were diagnosed radiographically to have multiple hepatic defects. The defects were shown histologically to be granulomatous. Two of the three patients had Warthin-Starry staining bacilli in the granulomas consistent with a diagnosis of Afipia felis. All three had positive cat-scratch skin test results. CONCLUSIONS: Cat-scratch disease in the absence of peripheral adenopathy is a heretofore unrecognized cause of fever of undetermined origin and may account for a small, but significant, percentage of children presenting with it.

Biopsy, Needle↗

Investigation of abnormal first-trimester gestations by color Doppler imaging.

Color Doppler imaging was employed to assess the uteroplacental circulation in abnormal first-trimester gestations. Included in the study were 40 blighted ova, 35 missed abortions, 10 trophoblastic diseases, and 3 ectopic gestations. Normal gestations served as a control group. Flow was detected more frequently in the blighted ova than in the missed abortions. Flow was detected in all cases of trophoblastic disease and ectopic gestations. Resistance to flow was significantly lower in the trophoblastic group as compared to the other groups.

Abortion, Missed↗

Cleft palate: confirmation of prenatal diagnosis by colour Doppler ultrasound.

We present a case of a twin with trisomy 47,XX+i(9p) in whom the diagnosis of cleft palate was confirmed by colour Doppler imaging demonstrating abnormal fluid flow across the fetal pharyngeal bone defect. Application of this technique in cases predisposed for this congenital lesion may prove beneficial in the diagnosis of the more subtle types of isolated cleft palate.

Abnormalities, Multiple↗

Prenatal sonographic assessment of early, rapidly growing fetal cervical teratoma.

Although malignant transformation of fetal cervical teratoma is extremely rare, perinatal morbidity is high and usually related to the size of the tumour, which may compromise fetal swallowing and subsequently lead to upper airway obstruction. We present a case in which mid-trimester serial sonography demonstrated markedly rapid early growth of a lesion of this type between 17 and 19 weeks' gestation indicating the aggressive nature of this tumour, assisting parental decision to terminate the pregnancy. Histopathology confirmed grade 3 immaturity of the lesion.

Adult↗

Twin-twin transfusion with abrupt onset of microcephaly in the surviving recipient following spontaneous death of the donor twin.

We describe a case in which twin-twin transfusion with fetal death of the donor at 23 weeks was complicated by suspected intracranial embolic insult of the surviving recipient twin. Dynamic transient intracranial ultrasonographic findings were noted with complete resolution by 28 weeks. Subsequent severe microcephaly of the survivor with no further growth of any of the cranial parameters beyond 25 weeks was thought to be a result of this very unusual pathophysiologic mechanism.

Adult↗

Massive hydronephrosis mimicking theca lutein cysts in association with partial hydatidiform mole.

We present an unusual case of partial hydatidiform mole in which extensive, multiple cystic structures encompassing the entire right abdomen and pelvis, initially thought to represent theca lutein cysts, were subsequently shown to consist of massive unilateral right hydronephrosis. Percutaneous nephrostomy decompression bypassing the ureteropelvic obstruction revealed functional renal parenchyma.

Adolescent↗

Complications of intercarpal arthrodesis.

Fifty patients who underwent intercarpal arthrodesis were retrospectively reviewed at an average follow-up period of 34 months. Eighteen patients had a good result, 16 results were fair, and 13 were poor. Thirty-six patients experienced some complication, and 25 patients underwent further surgical therapy: The most common indication for secondary surgery was nonunion (16 patients). Good results were significantly decreased among patients who experienced nonunion, required secondary surgery, or experienced any complication. Patients with static carpal instability treated by scaphoid trapezoid trapezium arthrodesis had a significantly greater proportion of good results.

Adolescent↗

Color Doppler imaging and in vivo assessment of the anatomy and physiology of the early uteroplacental circulation.

OBJECTIVE: To evaluate in vivo the anatomy and physiology of the normal early uteroplacental circulation. DESIGN: Forty-six women were included, all of whom continued their pregnancy into the second trimester. Color Doppler was used to identify peritrophoblastic flow, and spectral Doppler was used to analyze waveforms obtained from the different segments of the uteroplacental circulation. RESULTS: Flow was detected in the spiral arteries of the peritrophoblastic region in all patients. Flow was detected within the intervillous space in only one case. CONCLUSIONS: This study demonstrated that color Doppler imaging can be employed as an in vivo means of studying the uteroplacental circulation. The study confirmed the in vitro findings that trophoblastic invasion of the decidual spiral arteries occurs at 5 to 6 weeks' gestation. The study also confirmed the fact that there is no noticeable blood flow within the intervillous space during most of the first trimester of a normal pregnancy. Both of these findings may serve to protect the early gestation from the forces of arterial blood flow.

Adult↗

The pharmacokinetics of recombinant human relaxin in nonpregnant women after intravenous, intravaginal, and intracervical administration.

The pharmacokinetics of recombinant human relaxin (rhRlx) after intravenous (iv) bolus administration and the absorption of rhRlx after intracervical or intravaginal administration were determined in nonpregnant women. The study was conducted in two parts. In part I, 25 women received 0.01 mg/kg rhRlx iv. After a minimum 7-day washout period, these women were dosed intracervically (n = 10) or intravaginally (n = 15) with 0.75 or 1.5 mg rhRlx, respectively, in 3% methylcellulose gel. Part II was a double-blind, randomized, three-way crossover study in 26 women. At 1-month intervals, each woman received one of three intravaginal treatments consisting of 0 (placebo), 1, or 6 mg rhRlx in 3% methylcellulose gel. The serum concentrations of relaxin following iv administration were described as the sum of three exponentials. The mean (+/- SD) initial, intermediate, and terminal half-lives were 0.09 +/- 0.04, 0.72 +/- 0.11, and 4.6 +/- 1.2 hr, respectively. Most of the area under the curve was associated with the intermediate half-life. The weight-normalized clearance was 170 +/- 50 mL/hr/kg. The observed peak concentration was 98 +/- 29 ng/mL, and the weight-normalized initial volume of distribution was 78 +/- 40 mL/kg, which is approximately equivalent to the serum volume. If central compartment elimination was assumed, the volume of distribution at steady state (Vss/W) was 280 +/- 100 mL/kg, which is approximately equivalent to extracellular fluid volume. Vss/W could be as large as 1300 +/- 400 mL/kg without this assumption.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravaginal↗

Sonographic measurement of the fetal iliac bone: growth and relation to femur length in assessment of gestational age.

Diagnostic ultrasonography has given us the opportunity to diagnose several congenital malformations in utero. Skeletal dysplasias is a heterogeneous group of disorders of the skeleton. Although disorders of bone growth are often diagnosed in utero, it is usually a general diagnosis because the exact syndrome cannot be specified. This is due to the fact that many anomalies of the skeleton have similar features. The wing of the iliac bone can be either affected or normal in skeletal dysplasias and its appearance may help in the differential diagnosis. This study was undertaken to establish values for the width of the iliac bone wing during normal gestations and thus enable us to use it in the evaluation of fetal growth and the recognition of specific congenital anomalies.

Embryonic and Fetal Development↗