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S F Cramer

Publications and source records attributed to S F Cramer.

At least 19 recordsLinked to original sources
PubMed1996

The relation of fibrous degeneration to menopausal status in small uterine leiomyomas with evidence for postmenopausal origin of seedling myomas.

It is well known that uterine leiomyomas shrink after the menopause. Fibrosis is the most common type of myomatous degeneration, but its relationship to menopause has not been studied. We evaluated fibrosis in 237 small myomas (< 1 cm) in relation to menopause, tumor size, intrauterine location, and patient age. Substantial fibrosis was seen in 33 (21%) of 159 small premenopausal myomas versus 39 (50%) of 78 small postmenopausal myomas (P < 0.001). This relationship was even stronger for women between 40 and 60 years of age: 27 (21%) of 126 premenopausal women versus 12 (71%) of 17 postmenopausal women (P < 0.001). Only 23 (23%) of 101 2- to 4-mm myomas had substantial fibrosis versus 45 (40%) of 112 5- to 9-mm myomas (P < 0.01). Small postmenopausal myomas that were inframucosal had less frequent fibrosis (3 [27%] of 11) than their intramural and subserosal counterparts (36 [54%] of 67) (P = 0.05). There was a significant increase in seedling myomas (fully cellular myomas < 1 cm) from postmenopausal women aged 60 to 70 years (13 [35%] of 37) compared with younger postmenopausal women (1 [6%] of 17) (P < 0.01). We conclude that fibrosis is strongly associated with menopausal status in small uterine myomas, that size and location are also related to fibrosis in small myomas, and that seedling myomas may arise after the menopause. Our interpretation of these findings is that the most likely cause of fibrosis in small myomas is senescence and that there may be heterogeneity in the molecular basis of senescence.

Adolescent↗
PubMed1996

Fatal thrombotic thrombocytopenic purpura (TTP) presenting concurrently with metastatic multiple endocrine neoplasia (MEN) type I.

A 44-year-old women was treated for hyperparathyroidism resulting from parathyroid hyperplasia. Several months later, following a flu-like episode, she developed fever, confusion, abdominal pain, and diffuse petechiae, with severe thrombocytopenia and hemolytic anemia. She died on the 11th day of hospitalization. At autopsy she had multiple endocrine neoplasia type I, with two islet cell tumors, adrenal adenoma, pituitary adenoma, and bronchial carcinoid with liver metastasis. Florid visceral microthrombi involved arterioles and capillaries of the heart, including the conduction system. Brain, kidney, pancreas, adrenal, and portal areas of the liver were also heavily involved, but thrombi were rare in the liver sinusoids and the lungs. PAS-positive subendothelial deposits were demonstrated. In spite of the disseminated malignancy, the morphologic and laboratory findings were inconsistent with disseminated intravascular coagulation (DIC), and supported the clinical diagnosis of TTP. To the best of our knowledge this is the first report association of TTP with MEN and raises the question of a genetic linkage and/or hormonal interaction.

Adult↗
PubMed1995

Multiple aneurysms of the internal thoracic artery.

Nontraumatic aneurysms of the internal thoracic artery are rare. We report a case where multiple aneurysms of the right internal thoracic artery presented as an asymptomatic density on the chest radiograph. Operative findings and pathology are reviewed.

Aneurysm↗
PubMed1995

Septic pulmonary thrombosis in streptococcal toxic shock syndrome.

A 60-year-old woman who was previously in good health presented with a sore throat, fever, and a flu-like syndrome. Treated initially with acetaminophen and fluids for a presumed viral infection, she had a syncopal episode 4 days later, was admitted to the hospital, and died 3 hours after admission. Laboratory test results suggested sepsis with disseminated intravascular coagulation (DIC), whereas blood cultures grew group A beta-hemolytic streptococci. A postmortem diagnosis of streptococcal toxic shock syndrome was established. It was of particular interest that the pulmonary microcirculation was filled with thrombi that contained numerous gram-positive cocci. Although death from sepsis with DIC is not uncommon, septic pulmonary thrombosis has not been previously described. We speculate that this paradox may reflect unique properties of the virulent strains of Streptococcus pyogenes that are associated with streptococcal toxic shock syndrome.

Female↗
PubMed1995

Epidemiology of uterine leiomyomas. With an etiologic hypothesis.

OBJECTIVE: The few previous epidemiologic studies of uterine myomas have relied on clinical evaluation to select controls, but we previously showed that myomas may be present in more than 75% of such uteri. STUDY DESIGN: We therefore attempted to evaluate risk factors using age-matched controls whose uteri were serially sectioned to exclude the presence of myomas. RESULTS: The small study size precluded a meaningful evaluation of most parameters but tended to confirm the negative association of myomas with cigarette smoking (P = .07). CONCLUSION: Using monoclonal smooth muscle proliferation in human atherosclerotic plaques as a model, we suggest that excessive injury to and repair of the endometrial lining of the uterus may promote monoclonal expansion of smooth muscle cell populations in the uterine wall (i.e., myomas). This theory is largely compatible with the estrogen hypothesis, but fundamental principles of tumorigenesis and previous epidemiologic data on myomas suggest that nutritional factors should be scrutinized as possible initiators (DNA-damaging substances) in the pathogenesis of uterine myomas.

Adult↗
PubMed1995

Myometrial hyperplasia: proposed criteria for a discrete morphological entity.

Myometrial hyperplasia is not a well-established morphological entity. Technical obstacles regarding uterine weight, myometrial cellularity, and myometrial cell orientation have made it difficult to establish objective criteria for diagnosis. In this study, 15 slides that had been interpreted as within normal limits on routine examination were reevaluated because there were areas of myometrium that stood out as relatively blue on scanning magnification of H&E-stained sections. Morphometrically, they all had increased myometrial cellularity, compared with normal myometrium elsewhere on the same slide (P < 0.05), and an increased nucleus/cell ratio (P < 0.001). They occurred in three patterns. The diffuse inframucosal form and the subserosal plaque-like form sometimes corresponded to grossly detectable inframucosal bulges or subserosal ridges. There was also an occult, microscopic intramural pattern of myometrial hyperplasia, which differed from seedling leiomyomas by its lack of nodularity and compression of adjacent myometrium. We propose that these criteria may permit an objective diagnosis of myometrial hyperplasia. We believe that it will be of interest to explore the clinical significance, cell biology, and pathogenesis of this distinctive variation in myometrial structure.

Adult↗
PubMed1992

The nonrandom regional distribution of uterine leiomyomas: a clue to histogenesis?

Although uterine leiomyomas are a major public health problem, very little is known about their etiology or histogenesis. To seek clues as to why the myometrium so frequently gives rise to these tumors, we attempted to determine if the regional distribution of leiomyomas was uniform. It appears that the proportion of leiomyomas in the premenopausal (0.8%) and postmenopausal (3.7%) cervix may be substantially less than the proportion of smooth muscle in the premenopausal (7.3%) and postmenopausal (17%) cervix. These data suggest that the smooth muscle cells of the corpus uteri may be at higher risk for neoplastic transformation than those of the cervix. Within the corpus there appeared to be a relative excess of fundic leiomyomas (premenopausal, 89%; postmenopausal, 86%) as compared with fundic smooth muscle (premenopausal, 79%; postmenopausal, 61%). No such excess was apparent in the isthmus or cornu. Immunohistochemical studies of estrogen and progesterone receptors in premenopausal and postmenopausal myometrium were uniformly positive, with no regional differences to suggest a hormonal basis for regional susceptibility to leiomyomas. It may be fruitful to search for precursor lesions and other factors predisposing to neoplastic development in fundic myometrium.

Female↗