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R Yakulis

Publications and source records attributed to R Yakulis.

13 recordsLinked to original sources
PubMed1999

Herpes simplex peritonitis: case report.

It has been previously reported that the most common cause of peritonitis in patients undergoing chronic ambulatory peritoneal dialysis (CAPD) is infection by a single gram-positive bacterial species. Polymicrobial bacterial infections are identified that may be secondary to bowel perforation. In 20% of cases bacterial cultures are negative. Although cultures may be negative when infection is due to a fastidious organism, when antibiotic therapy has been administered, and in cases of chemical peritonitis, a viral etiology should also be considered. We report the first documented case of herpes simplex peritonitis, which involved a 60-year-old female undergoing CAPD. Viral peritonitis may be an important form of peritonitis that has been previously unrecognized and should be considered in the differential diagnosis.

Female↗
PubMed1998

Intraosseous meningioma.

A 71-year-old woman with a long history of slowly progressive proptosis was found to have an intraosseous meningioma of the right sphenoid bone. Radiologically, the lesion resembled fibrous dysplasia. The key to the diagnosis is irregularity of the inner table of the skull. The histologic appearance is characteristic. Intraosseous meningioma is one part of the spectrum of diseases known as primary extraneuraxial meningioma. In this paper we discuss the theories of cellular origin as well as the radiologic differential diagnosis.

Aged↗
PubMed1998

U.S. case report of cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (R. mackenziei): criteria for identification, therapy, and review of other known dematiaceous neurotropic taxa.

We report a case of cerebral phaeohyphomycosis in a 36-year-old male caused by the neurotropic fungus Ramichloridium obovoideum (Matushima) de Hoog 1977 (Ramichloridium mackenziei Campbell et Al-Hedaithy 1993). This man resided in the Middle East, where the fungus appears to be endemic and, possibly, geographically restricted, since all previous reports of brain abscesses due to this organism have been for patients indigenous to this area. As a servant of the Saudi Arabian royal family, he appeared in the United States seeking treatment for chronic weight loss, fatigue, decreased memory, and a more recent 2-week history of right-hand weakness which worsened to involve the entire right upper extremity. On the day prior to his admission, he had a focal motor seizure with rotation of the head and eyes to the right, followed by secondary generalization. A computerized tomogram showed a ring-enhancing hypodense lesion in the left parietal subcortical region with associated edema and mass effect. Diagnosis of a fungal etiology was made following a parietal craniotomy and excisional biopsy by observation of septate, dematiaceous hyphal elements 2 to 3 microm in width on hematoxylin-and-eosin-stained sections from within areas of inflammation and necrosis. Culture of the excised material grew out a dematiaceous mould which was subsequently identified as R. obovoideum. At two months postsurgery and with a regimen of 200 mg of itraconazole twice a day, the patient was doing well and returned to Saudi Arabia. His condition subsequently deteriorated, however, and following a 7-month course of itraconzole, he expired. We use this case to alert clinicians and personnel in clinical mycology laboratories of the pathogenicity of this organism and its potential occurrence in patients with central nervous system signs and symptoms who have resided in the Middle East and to review and/or compare R. obovoideum with other neurotropic, dematiaceous taxa and similar nonneurotropic, dematiaceous species.

Adult↗
PubMed1998

Intracellular coexpression of epidermal growth factor receptor, Her-2/neu, and p21ras in human breast cancers: evidence for the existence of distinctive patterns of genetic evolution that are common to tumors from different patients.

Multiparameter flow cytometry studies were performed on cells from the primary tumors of 94 patients with breast cancer. Correlated cellular measurements of cell DNA content, Her-2/neu, epidermal growth factor receptor (EGFR), and p21ras levels were performed on each of 5,000 to 100,000 cells from each tumor. When criteria for positivity were matched with those in common use for immunohistochemical studies, 28 of 94 (30%) breast cancers were classified as positive for Her-2/neu overexpression. When similar criteria were applied to the EGFR measurements, 23 of 94 (24%) cases were classified as positive for EGFR overexpression. Similarly, 23 of 94 (24%) cases were classified as positive for p21ras overexpression. By conventional flow cytometric criteria for DNA ploidy, 24 cases were diploid, 28 were tetraploid, and 42 were aneuploid. When the measurements were treated as separate sets of data, the only statistically significant correlations noted were the high frequency of diploid tumors, which did not overexpress any of the three oncogenes studied (P < 0.05), and an association between Her-2/neu overexpression and aneuploidy (P < 0.03). When the data were treated as correlated intracellular measurements, 90 of the 94 tumors studied contained a population of cells in which the intracellular levels of Her-2/neu expression were directly correlated with the levels of EGFR expression in the same cells. The ratio of Her-2/neu molecules to EGFR molecules in the same cells exceeded 1 in the majority of tetraploid and aneuploid cases and was close to or less than 1 in the majority of diploid cases. In nearly all tumors, p21ras overexpression was observed only in cells that overexpressed Her-2/neu, EGFR, or both, and p21ras levels per cell were more closely correlated with levels of EGFR per cell in the same cells than with Her-2/neu levels per cell. The data are consistent with a model in which heterodimerization of Her-2/neu and EGFR in individual cells is achieved by one of several genetic evolutionary pathways, all of which commonly lead to p21ras overexpression. The two major genetic evolutionary pathways identified in this study are an aneuploid, Her-2/neu overexpression-driven pathway seen in 59 of 94 tumors, and a diploid, EGFR overexpression-driven pathway seen in 19 of 94 tumors. All tumors with Her-2/neu:EGFR ratios greater than 2 contained an infiltrating ductal carcinoma component, whereas all infiltrating pure lobular carcinomas had Her-2/ neu:EGFR ratios that were less than 2. All of the genetic evolutionary pathways identified in this study were represented among the 11 tumors from patients who experienced early tumor recurrences.

Analysis of Variance↗
PubMed1996

Postradiation malignant triton tumor. A case report and review of the literature.

OBJECTIVE: To report the third case of postradiation malignant triton tumor and to review the literature on malignant triton tumor with regard to features of possible prognostic significance. DATA SOURCES: Published articles were retrieved through MEDLINE, and additional articles were obtained through searches of the bibliographies. STUDY SELECTION: Cases were selected on the basis of histologic, immunohistochemical, and ultrastructural studies of malignancies showing both neurogenic and myogenic differentiation. Only those cases with survival data were selected for analysis. DATA EXTRACTION: The relationship between survival time and the possible prognostic variables of sex, presence or absence of von Recklinghausen's disease, age, and tumor location were evaluated by Cox regression analysis. RESULTS: Kaplan-Meier analysis showed a 5-year specific survival of 26%. Tumor location showed a statistically significant association with survival time (P = .01). CONCLUSIONS: This study suggests that malignant triton tumors occurring in the upper extremities, lower extremities, and head and neck have a better prognosis than tumors located in the retroperitoneum, buttock, or trunk. It is not clear if this variation is due to a difference in tumor grade, tumor stage, or resectability, or if it is a consequence of therapy.

Adolescent↗
PubMed1995

Aneuploidy in breast cancer: a fluorescence in situ hybridization study.

Although ploidy is associated with the development and progression of most breast cancers, the value of flow cytometric ploidy as a clinical prognostic factor remains controversial. The technique of fluorescence in situ hybridization (FISH) can be used not only to determine overall ploidy, but also to assess the over-representation or under-representation of specific chromosomes in interphase cells. This information may be of prognostic value. We studied 84 primary breast cancers and 20 metastatic tumors by FISH, using chromosome-specific fluorescent centromeric probes. Of these, 100 cases were also studied by DNA flow cytometry. The FISH studies were concordant with DNA flow cytometry with regard to distinguishing aneuploid from diploid tumors in 78% of cases. The FISH data suggested that aneuploidy arises by a process of chromosome complement doubling with subsequent chromosome loss. In tumors that exhibited evidence of more than one round of chromosome complement doubling, the selective accumulation of multiple copies of specific chromosomes or chromosome segments was common. Multiple copies of chromosomes centromeres 1, 3, and 17 were accumulated selectively in the cells of individual tumors more frequently than chromosomes centromeres 7, 11, and 16. Multiple copies of chromosomes centromeres 10 and 20 were selectively accumulated only rarely, if at all. Aneuploidy in breast cancer can be divided into distinct stages using fluorescence in situ hybridization techniques. The stages of aneuploidy provide potential landmarks in the genetic evolution of this disease with possible links to chromosome-specific evolutionary changes.

Aged↗
PubMed1995

Origins and clinical implications of aneuploidy in early bladder cancer.

Cytogenetic and flow cytometric studies in a variety of human solid tumors have suggested that gross aneuploidy may arise by a process of abrupt chromosome complement doubling followed by gradual chromosome loss. However, this sequence has not been demonstrated directly in serial studies in individual patients in vivo. The purpose of this study was to search for evidence of chromosome complement doubling and subsequent chromosome loss in flow cytometric ploidy patterns in serial bladder washings and/or biopsies from individual patients with early bladder cancer. Fifty-two patients with noninvasive bladder cancer were followed with serial flow cytometric DNA studies for periods ranging from 5.1 to 42.7 months (median 15.1 months). Serial changes in DNA ploidy and S phase fractions were recorded and correlated with histologic and/or cytologic findings, response to treatment and clinical outcome. The data suggest a series of genetic evolutionary changes in early bladder cancer that include the initial development of peridiploid aneuploidy and repeated rounds of DNA content doubling with chromosome loss in patients with progressive disease. It is likely that gross DNA aneuploidy, and more specifically, DNA multiploidy and DNA hypertetraploidy, all arise by this mechanism. The sequence of DNA diploidy, peridiploid aneuploidy, near-tetraploidy, hypotetraploidy and hypertetraploidy is associated with a progressive increase in S phase fraction, and with increasing tumor grade; late steps in this ploidy sequence were often present in tumors that were refractory to local therapeutic measures and tumors that developed deep tumor invasion and/or distant metastases. We conclude that DNA multiploidy and hypertetraploidy are markers of advanced stages of genetic evolution in human bladder cancer.

Adult↗
PubMed1995

Assessing sequential oncogene amplification in human breast cancer.

Studies of amplification and/or overexpression of c-myc, HER-2/neu, and H-ras in breast cancer have shown that each is associated with a poor prognosis. The purpose of this study was to explore the possibility that there is a preferred sequence of amplification of these oncogenes in breast cancer. The frequencies of amplification and patterns of co-amplification of c-myc, HER-2/neu, and H-ras were studied in a group of 84 breast cancers. The data suggested a preferred sequence of amplification that consisted of c-myc amplification-HER-2/neu amplification-H-ras amplification. This model was supported by loglinear analysis. In addition, the levels of amplification of JC-A, a DNA fragment newly isolated from a patient with advanced breast cancer, were studied in 61 of these cases. The data suggested that JC-A amplification occurred early. Loglinear analysis supported a model in which JC-A amplification occurred either before or after c-myc amplification but was unrelated to Her-2/neu or ras amplification.

Adenocarcinoma↗
PubMed1983

Löffler's endocarditis. Occurrence with malignant lymphoma with a high content of epithelioid histiocytes ('Lennert's lymphoma').

In a patient who had malignant lymphoma with a high content of epithelioid histiocytes (so-called Lennert's lymphoma), Löffler's endocarditis developed 18 months after her diagnosis of lymphoreticular malignant neoplasm. She died of refractory congestive heart failure, and an autopsy showed the typical gross and microscopic findings of Löffler's endocarditis. To our knowledge, this is the first reported association of these two diseases. We noted nine autopsy cases in the literature of Löffler's endocarditis occurring in patients with lymphoreticular malignant neoplasms (acute lymphoblastic leukemia and lymphoma). Löffler's endocarditis with eosinophilia may be a relatively uncommon but significant complication in patients with malignant lymphoproliferative disorders. The peripheral blood eosinophilia probably represents a reactive response to tumor antigen.

Autopsy↗
PubMed1981

Right splenorenal fusion with associated hypersplenism.

We report the second case of splenorenal fusion and the first occurrence of spleen fusion associated with a right retroperitoneal structure. Hypersplenism was cured by removal of the mass. A concomitant renal cell carcinoma and multiple adenomas within the mass were incidental clinical features. Aside from the rarity of the lesion, its documented occurrence on the right side is significant in that it provides evidence for the possible migration of spleen cells in embryogenesis as an explanation for some other splenic fusion anomalies.

Adenocarcinoma↗
PubMedDate not supplied

Fine needle aspiration diagnosis of orbital plasmacytoma with amyloidosis. A case report.

Fine needle aspiration (FNA) cytology of the orbit was used to diagnose an unusual case of multiple myeloma with secondary amyloid deposition in a 27-year-old man who presented with bilateral keratoconjunctivitis and left-sided ptosis. The FNA smears revealed immature plasma cells, extracellular eosinophilic material (amyloid) and numerous multinucleate giant cells. Subsequent histologic studies of excised tissue confirmed the cytologic diagnosis of plasmacytoma with secondary amyloidosis. Amyloid was further confirmed by electron microscopy. The patient was subsequently diagnosed as having multiple myeloma. The cytologic features of amyloidosis and plasmacytoma are presented. The differential diagnosis and the diagnostic utility of FNA cytology in the evaluation of these orbital lesions are also discussed. This apparently was the first case of orbital amyloidosis diagnosed by FNA cytology.

Adult↗
PubMedDate not supplied

The accumulation of multiple genetic abnormalities in individual tumor cells in human breast cancers: clinical prognostic implications.

PURPOSE: Human solid tumors undergo multiple genetic evolutionary changes as they evolve from the normal state to advanced stages of malignancy. This study characterizes the degree of advancement of primary human breast cancers in their genetic evolutionary pathways, and determines if this is of clinical significance. MATERIALS AND METHODS: Correlated cell-by-cell measurements of cell DNA content, HER-2/neu protein content per cell, and H-ras protein content per cell were obtained by means of multiparameter flow cytometry on primary tumors from 95 patients with clinically localized breast cancer. Laboratory findings were correlated with subsequent clinical course in 91 of these patients. RESULTS: Multiple genetic abnormalities were found to accumulate in individual cells in primary human breast cancers. Almost all tumors contained subsets of cells with one, two, or three abnormalities per cell in various combinations. After a median follow-up time of 32 months, 11 of 13 patients with early recurrence had primary tumors in which more than 5% of cells were hypertetraploid, overexpressed HER-2/neu protein, and overexpressed H-ras protein (triple-positive cells). The duration of disease-free survival among patients with primary tumors that contained triple-positive cells was significantly shorter than for patients whose tumors did not contain triple-positive cells. The presence of subpopulations of cells with maximums of only one abnormality per cell or only two abnormalities per cell, in any combination, was of no prognostic significance. Among patients whose nodal status was known, 12 had recurrent disease, and all had positive axillary nodes. Among 36 patients known to have negative axillary nodes, no recurrence has been reported to date. CONCLUSIONS: The number of genetic abnormalities that accumulate in individual cells in primary breast cancers reflects the degree of advancement of a tumor in its genetic evolutionary sequence, and provides useful clinical prognostic information. Because follow-up duration is still relatively short, and because disease in node-negative patients tends to recur later than in node-positive patients, it is still too early to know if three measurements per cell will be sufficient to improve prognosis in node-negative disease.

Breast Neoplasms↗