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S K Suvarna

Publications and source records attributed to S K Suvarna.

At least 19 recordsLinked to original sources
PubMed2002

Monitoring tumour cells in the peripheral blood of small cell lung cancer patients.

BACKGROUND: Flow cytometry was used to enumerate tumour cells in longitudinal studies of peripheral blood from small cell lung cancer (SCLC) patients, together with magnetic bead selection to isolate and identify these cells. As part of a trial, 11 patients received either standard (four weekly) chemotherapy with ifosfamide, carboplatin, and etoposide (ICE) or accelerated (two weekly) ICE with filgrastim (granulocyte colony-stimulating factor [G-CSF]) and autologous stem cell support. METHODS: Fresh venous blood was taken throughout treatment and follow-up. Aliquots were stained with a "tumour-specific" antibody against epithelial tissue (Ber EP4), verified as a good marker of SCLC cells by immunohistochemistry. Matched samples labelled with Ber EP4 were separated magnetically by adding a secondary bead-antibody conjugate for confirmation of tumour cell identity. RESULTS: Circulating tumour cells were detected and monitored throughout treatment periods. An initial rise in circulating cells after the first cycle was followed by a fall in both treatment arms to baseline levels set by normal controls. This was achieved by week 12 in the accelerated treatment arm and by week 24 in the standard arm. CONCLUSIONS: Flow cytometry and magnetic bead isolation can be used to identify changes in numbers of circulating tumour cells in patients undergoing chemotherapy for SCLC and thereafter during follow-up periods. Absence of tumour cells may indicate a more favourable patient group who would benefit from a more intense course of treatment.

Antibody Affinity↗
PubMed2002

Do plastic surgeons resect basal cell carcinomas too widely? A prospective study comparing surgical and histological margins.

Basal cell carcinoma is a common condition facing the plastic surgeon. When formally excised, a surrounding margin of normal skin is included in an attempt to ensure complete excision. We set out to investigate our excision margins in a prospective study of 100 basal cell carcinomas in 86 patients treated by conventional surgical excision. The edge of each lesion was delineated, an excision margin was drawn, and the closest point was identified and measured. The tumours were excised, and the specimens were examined to determine the closest histological margin. A comparison was made between the marked surgical margins and the margins observed on microscopy. The mean observed surgical margin was 3.0 mm and the mean histological margin was 3.7 mm; 44% of the margins agreed to within 1 mm, 79% to within 2 mm and 92% to within 3 mm. There were four incomplete excisions, all at the lateral margin. There was agreement in the position of the closest margin in 69% of cases. The measured surgical excision margins correlated well with those assessed histologically, as did the position of the closest margin. Given a 3 mm margin, 96% of lesions would have been excised completely. We feel that our current practice represents a satisfactory balance between maintaining a low rate of incomplete excision and minimising the sacrifice of normal skin.

Adult↗
PubMed2002

Audit of clinical and histological prognostic factors in primary invasive squamous cell carcinoma of the skin: assessment in a minimum 5 year follow-up study after conventional excisional surgery.

In an attempt to evaluate the prognostic factors for primary squamous cell carcinoma of the skin treated by conventional surgery, a 6 year (1990-1995) cohort comprising 171 patients was analysed. Of these 171 patients, 157 were confirmed as having been treated for invasive squamous cell carcinoma, of whom 64 (41%) died within 5 years of treatment from causes other than squamous cell carcinoma, and were therefore defined as indeterminate. The remaining 93 patients were determinate patients; 85 lived without recurrence or metastasis for at least 5 years after treatment, and eight died of their disease. Comparing the groups who were alive or had died of disease at 5 year follow-up, the tumour diameter and tumour thickness were significantly greater in the eight patients who died (P = 0.02 and P = 0.0057, respectively) but there were no significant differences between the two groups with regard to age, deep resection margin clearance, lateral epidermal resection margin clearance, lymphocyte response or degree of tumour differentiation. This study defines the 5 year follow-up outcome following conventional surgery for squamous cell carcinoma of the skin, related to histological parameters, which, if routinely reported, would allow valid comparisons to be made between differing primary therapies.

Adult↗
PubMed2001

Histopathology and the 'third great lie'. When is an image not a scientifically authentic image?

This article considers the issues of image manipulation within the context of electronic/digital images. The possibility for such alterations has occurred with the increasing availability of simple and cheap computer software, permitting modification of digitized images as a whole, or in part. The concepts of acceptable, through to unacceptable, manipulations are discussed using macroscopic and histological illustration examples. The legal and editorial problems that this poses for medical and scientific publishing are also discussed, alongside examples of previous fraudulent image publications and the historical context of valid scientific images.

Humans↗
PubMed2001

Osseous metaplasia as a cause of loss of extension after anterior cruciate ligament reconstruction.

We report a case of osseous metaplasia of an autologous anterior cruciate ligament (ACL) reconstruction that was implicated in blocking extension of the knee. Nonoperative treatment was unsuccessful. Arthroscopic excision of the ACL and osseous metaplasia abolished the fixed flexion deformity. The osseous metaplasia was an additional factor in causing the block to extension along with an anteriorly placed femoral tunnel, raising the question that nonisometry of the graft may be involved in the pathogenesis of the osseous metaplasia.

Adult↗
PubMed2001

Electron microscopy of myocardial tissue. A nine year review.

AIM: To review and reassess the role of this department's experience with routine electron microscopy of myocardial tissues. METHODS: A nine year series of myocardial samples that underwent electron microscopy analysis were audited. Fifty nine samples were derived from 46 male and 13 female subjects with an age range of 15-90 years (mean, 50.6). Forty two samples were endomyocardial specimens, with 13 being derived from explanted hearts, and four from necropsies. Two cases were from transplanted hearts. These were all reviewed in a blinded fashion, by all three authors separately, in terms of the myocardium at the ultrastructural level. Subsequently, the interpretations/diagnoses were cross compared with the light microscopy and clinical data results. [figure: see text] RESULTS: Four cases of amyloid were identified; in addition, one case of granulomatous inflammation and one case of basophilic degeneration were seen, although all these had been evident on light microscopy. One case of possible mitochondrial myopathy was found. A total of 18 cases revealed changes of a presumed non-specific type including glycogen, lipid, and mitochondrial accumulations. Varying types of degeneration involving myofibres were seen together with variations in interstitial fibrosis and occasional cytoplasmic inclusions. CONCLUSION: Overall, although interesting, the electron microscopy of myocardial tissue added little to the understanding of the patient's disease, with only one case showing changes not found at light microscopy or with other investigations. Further study might shed light on the "non-specific" ultrastructural findings encountered.

Adolescent↗
PubMed2000

Fatal fungal infection complicating aortic dissection following coronary artery bypass grafting.

The case of a 52-year-old man with severe coronary atheroma/ischaemic heart disease, who underwent successful triple vessel coronary artery bypass grafting is described. One month later this was complicated by aortic dissection arising at the aortic cannulation site. An emergency resection and Dacron graft placement were performed. Five weeks later he represented with haemoptysis. Despite inconclusive investigations the patient went on to suffer a massive fatal haemoptysis. Autopsy revealed Candida infection of the graft with a secondary aortobronchial fistula.

Aortic Dissection↗
PubMed2000

Acute right-to-left inter-atrial shunt; an important cause of profound hypoxia.

Three patients presented to our intensive care unit over a 3-yr period with profound hypoxia resulting from acute right-to-left inter-atrial shunt (RLIAS). Patient 1 was a 67-yr-old male with an atrial septal defect who became hypoxic and developed the rare sign of platypnoea following elective repair of an abdominal aortic aneurysm (breathlessness made worse when upright and relieved by lying flat). Patient 2 was a 38-yr-old female who developed platypnoea and hypoxia secondary to a patent foramen ovale (PFO) and pericardial effusion. Patient 3 was a 46-yr-old male with a PFO who developed hypoxia without platypnoea because of multiple pulmonary emboli following right hemicolectomy. These case reports illustrate the need to consider RLIAS as a cause of hypoxia of sudden onset. Early use of bubble contrast echocardiography is indicated.

Acute Disease↗
PubMed2000

Necropsy diagnosis of myocarditis: a retrospective study using CD45RO immunohistochemistry.

AIM: To use CD45RO immunohistochemistry to investigate the numbers of T lymphocytes found in sections of myocardium from a routine necropsy series, and to determine the incidence of myocarditis in this series. METHODS: Myocardial sections from 163 routine hospital necropsies were stained with CD45RO and the numbers of positive lymphocytes/mm2 were counted. The results were correlated with the H/E opinion and the clinical context of the necropsy. RESULTS: Most (143) cases showed low numbers (0-3) of CD45RO positive lymphocytes/mm2. Fifteen cases showed 7-13 positive lymphocytes/mm2, comprising a wide variety of clinical conditions, generally with no specific cardiac pathology. Five cases showed 14 or more positive lymphocytes/mm2, comprising one case of active myocarditis, three cases of cardiac transplant rejection, and one post-transplant lymphoproliferative disorder, all conditions in which large numbers of lymphocytes would be expected. CONCLUSIONS: The incidence of myocarditis in our series was 0.6%. In most cases the normal myocardium has a low T lymphocyte count (0-3/mm2). In some cases immunohistochemistry shows more positive cells than would have been expected on light microscopy. Immunohistochemistry is a useful and reliable means of confirming a diagnosis of myocarditis. The results support the conclusion of the 1997 ISFC task force that 14 or more lymphocytes or macrophages/mm2 of myocardium in the appropriate clinical context is a reliable threshold for the diagnosis of chronic myocarditis.

Adolescent↗
PubMed2000

Malignant vascular tumours of the pleura in "asbestos" workers and endothelial differentiation in malignant mesothelioma.

BACKGROUND: Three cases of diffuse malignant vascular tumours of the pleura are described which mimicked malignant mesothelioma clinically and pathologically (so called "pseudomesothelioma"). All had occupational histories of exposure to asbestos. The relationship of these tumours to mesothelioma and asbestos exposure is discussed. METHODS: To examine the histogenetic relationship between mesothelioma and these three tumours an immunohistochemical analysis of vascular marker (CD31, CD34, and Von Willebrand factor) expression was undertaken in 92 cases of pleural mesothelioma, in addition to these three tumours. Electron microscopic fibre analysis of lung tissue was performed on each of the three cases to assess asbestos fibre content. RESULTS: Diffuse pleural epithelioid haemangioendotheliomas may closely resemble malignant mesothelioma clinically and pathologically but, of the 92 pleural mesotheliomas tested, none showed expression of CD31, CD34, and Von Willebrand factor. Although all three cases had claimed exposure to asbestos, ferruginous bodies typical of asbestos were only seen by light microscopy in case 2, and only in this subject was the asbestos fibre content raised in comparison with the range seen in a non-exposed background population. The latent period in the pleural epithelioid haemangioendotheliomas ranged from 18 to 60 years. CONCLUSIONS: Endothelial differentiation does not appear to occur in mesothelioma and therefore should be clearly separated from it. No definite association between pleural epithelioid haemangioendothelioma and exposure to asbestos can be made from this small series but further investigation is warranted.

Adult↗
PubMed2000

Small cell lung carcinoma presenting as acute cardiovascular collapse due to tumour cell embolisation.

We present a case of small cell lung carcinoma causing acute cardiovascular collapse due to pulmonary tumour emboli. Although pulmonary tumour emboli may complicate a number of malignancies, this is rarely seen in cases of carcinoma of the bronchus. Patients suffering with pulmonary tumour emboli often have previous symptoms, and show progressive dyspnoea. To our knowledge there have been no reports of tumour emboli presenting acutely without any previous history of symptoms.

Angiography↗
PubMed1999

Lack of association between thyroid and adrenal nodules: a histological study.

The prevalence of thyroid nodules is increased in patients with Cushing's disease, but the possibility of an association between thyroid and adrenal nodules in other patient groups has not been formally tested. We have evaluated the co-existence of thyroid and adrenal nodules in retrospective and prospective autopsy studies. Retrospective (83 autopsies) and prospective (29 autopsies) blinded studies of thyroid and adrenal gland histopathology were performed by two experienced histopathologists in unselected autopsies. The presence of nodules, defined as areas of tissue having discrete edges within the gland parenchyma seen as a step difference between the cells or architecture adjacent to the nodule, was determined for each gland. No association was found between the presence of adrenal and thyroid nodules in either the retrospective or prospective studies (p>0.2 for both). In the retrospective study, 23% of specimens had thyroid nodules and 28% adrenal nodules. In the prospective study, 24% of specimens had thyroid nodules and 7% adrenal nodules. The proportion of patients with adrenal nodules in the prospective study was significantly less than that in the retrospective study. In conclusion, thyroid and adrenal nodules are frequent autopsy findings in the general population but we have found no evidence of a relationship between the occurrence of nodules in these glands.

Adrenal Gland Diseases↗