PubMed Health⌕ Search

Biomedical subjects

S Kay

Publications and source records attributed to S Kay.

At least 91 records · Page 5Linked to original sources
PubMed1990

Computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis.

In this study, the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system. Fourteen percent of the patients were classified as Stage I (single-focus disease); 36% as Stage II (multifocal disease responsive to conservative therapy); 32% as Stage III (diffuse disease partially responsive to medication); and 16% as Stage IV (diffuse disease associated with bony changes and poorly responsive to conservative treatment). The incidence of recurrent or persistent disease ranged from 13% for Stage II to 30% for Stage IV. Stage I and III patients had 13% and 18% recurrence rates, respectively. Computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticator of the disease process.

Chronic Disease↗
PubMed1990

Characterization of a simplified method of cryopreserving human parathyroid tissue.

Cryopreservation of human parathyroid tissue plays an important role in managing difficult parathyroid disease. It also can permit investigators to conduct experiments without dependence on the operating room schedule. Availability of cryopreservation has been limited by the perceived need for expensive, complex equipment. We adapted a simple method of freezing cell suspensions to freezing human parathyroid tissue. Vials containing human parathyroid in culture media, dimethylsulfoxide, and patient serum were placed in a plastic rack in a metal pan containing prechilled (4 degrees C) ethanol and placed in a -70 degrees C freezer. We compared viability (trypan blue dye exclusion by collagenase dispersed cells) of tissue frozen in this manner to that of tissue frozen in a programmable liquid nitrogen freezer at 1 degrees C per minute, a cooling rate recommended for human parathyroid tissue. The viability of 30 patients' samples cooled in liquid nitrogen (average length of storage 5 months) was 74% +/- 15% and that of 64 patients' samples cooled in ethanol (average length of storage 26 months) was 71% +/- 15%. Viability of 19 samples of fresh tissue was 79% +/- 10%. Neither method had a statistically significant correlation between length of storage and viability. Successful cryopreservation with simplified technology may expand the availability of parathyroid tissue to meet both clinical and investigative requirements.

Cell Survival↗
PubMed1990

B cells in thymomas.

Although previous studies demonstrated thymoma-associated lymphocytes to be T cells, six thymomas were identified with germinal centers (GC) inside the tumor capsule. Three were mixed lymphocytic and epithelial thymomas. These tumors contained GC interspersed throughout and were not associated with myasthenia gravis (MG) or with GC in adjacent thymus. Three other tumors were lymphocytic thymomas with subcapsular GC. These thymomas occurred in MG patients and were associated with GC in adjacent non-neoplastic thymus. Immunoperoxidase studies using antibodies LN1, LN2, and L26 confirmed the presence of B cells in thymomas, particularly those with germinal centers. The presence of B cells in certain thymomas must be considered when studying the association of Epstein-Barr virus with thymic tumors. Germinal centers in a thymoma are not necessarily associated with myasthenia gravis.

Antibodies, Monoclonal↗
PubMed1989

Nerve sheath myxoma of digital nerve.

A case of a dermal nerve sheath myxoma arising in a digital nerve is reported. Similar tumors and its variants have been termed neurothekeoma, pacinian neurofibroma, bizarre cutaneous neurofibroma, and plexiform neurofibroma. The perineural sheath or the Schwann cell have been presumed to be the cell of origin by several investigators. The positive reaction with antibody to S-100 would appear to favor the Schwann cell as the progenitor of this tumor.

Adult↗
PubMed1989

Natural history and treatment of mucosal melanoma.

Forty-three patients with primary mucosal melanomas seen between 1960 and 1987 were reviewed. There were 17 patients with tumors arising from the head and neck, 17 from the vulva and/or vagina, 8 from the anorectum, and 1 from the esophagus. Twenty-one patients were resected with curative intent. In patients with head and neck tumors, local recurrence was the initial cause of failure in the majority of cases, whereas with tumors arising from the anorectum, vulva, and vagina, systemic recurrence was more common. There were four long-term survivors, and three of these had melanomas less than 1 mm thick with negative regional lymph nodes; no patients with mucosal melanoma less than 1 mm thick developed recurrent disease. Overall, actuarial survival was 64% after 1 year and 23% after 5 years. Mucosal melanoma has a poor prognosis, and adequate resectional surgery affords the only chance of long-term survival.

Actuarial Analysis↗
PubMed1989

Ring avulsion injuries: classification and prognosis.

Fifty-five cases of ring avulsion injury were reviewed to examine how extent of injury and surgical management correlated with results. After injury, three patients had adequate circulation. Of 52 patients with inadequate circulation, 8 had primary amputation; salvage was attempted in 44. Of these 44, 9 fingers were amputated secondarily, 19 were successfully revascularized, and 16 were successfully replanted. Return-to-work time averaged between 4.5 and 10.3 weeks. Cold symptoms occurred in 65% of salvaged fingers. Range of motion was usually normal at the metacarpophalangeal joint; most patients had 90 degrees or better combined arc of motion at the proximal and distal interphalangeal joints. Two-point discrimination of less than 10 mm returned in 47% of patients with injured nerves. Most patients whose fingers were successfully salvaged were glad they had had the procedure. We conclude that amputated digits are salvageable and propose a classification system that includes skeletal injury.

Adolescent↗
PubMed1989

Segmental medullary sponge kidney mimicking a renal mass.

We report an unusual case of a medullary sponge kidney that presented clinically and radiologically as a renal mass. Histopathological study after nephrectomy proved the mass to be consistent with segmental medullary sponge kidney.

Diagnosis, Differential↗
PubMed1989

Management of desmoid tumors.

Desmoid tumors are rare, being less than 0.03 per cent of all neoplasms. Because of scarcity of data and relatively small numbers of patients, optimal treatment remains controversial. In this report, our experience with 36 patients evaluated and treated from 1960 to 1987 is analyzed. The most common primary site was the wall of the chest (ten); eight tumors originated in the abdominal wall. Nine patients had a history of previous trauma, and eight of these were women. Thirty-two patients had wide local excision and two had amputations. Clear margins were obtained in only 22 patients despite an attempt at wide resection in all instances. With a mean follow-up period of 41 months and a median of 24 months, only one of 22 patients with negative histologic margins had recurrence of tumor. Among the 11 patients with positive margins, four received postoperative radiation therapy and two remain disease-free; of the seven remaining patients with positive margins, three had recurrences. One patient with unresectable disease was treated with tamoxifen with regression of tumor and remains alive 15 months later. These data suggest that the best treatment of desmoid tumors remains resection with a clear margin of normal tissue surrounding the tumor. Adjuvant radiotherapy did not appear to decrease the rate of local recurrence.

Actuarial Analysis↗
PubMed1988

Late presentation of ulcerative colitis in ex-smokers.

Details of the smoking history were obtained from 288 patients with ulcerative colitis who were more than 15 years of age when colitis developed. Men who had previously smoked presented with colitis at a later age than lifelong non-smokers (mean age difference 15.2 years). The proportion of ex-smokers in this group of patients with colitis was more than twice that expected in the general population. The interval between cessation of smoking and subsequent onset of colitis in ex-smokers was found to be relatively short and in two-thirds of patients occurred within seven years. A tentative model to explain the association between smoking and subsequent colitis is proposed. We suggest that whilst current smokers may have a lower incidence of colitis, ex-smokers appear to be at increased risk of developing the disease. An alternative explanation is that smoking may act in a manner analogous to sulphasalazine.

Adult↗
PubMed1988

Principles in the management of pediatric intestinal leiomyosarcomas.

Primary intestinal leiomyosarcomas in children are unusual tumors with little known about their natural history. Two patients (aged 9 and 10 years) with leiomyosarcoma of the jejunum treated at our institution are reported and added to the 20 other patients reported in the literature. The first patient had a grade 1 leiomyosarcoma completely resected, received no additional therapy, and remains alive with no evidence of disease 14 years later. The second patient presented with a perforated grade 2 leiomyosarcoma which was incompletely resected; he received combination chemotherapy with an initial good response, but eventually died from sarcomatosis 7 years after initial diagnosis. The 22 cases of pediatric intestinal leiomyosarcoma presented more commonly with obstruction or perforation, were able to be completely resected more often, and appear to have a better prognosis than in adults. Thus, intestinal leiomyosarcomas in children appear to have a natural history different from that of the same tumor arising in adults.

Child↗
PubMed1988

Endometrial carcinoma arising in a large polypoid adenomyoma of the uterus.

A case of endometrial carcinoma arising in a large adenomyomatous polyp is described in a 75-year-old woman. The malignant element appeared to be a mixed adenosquamous carcinoma that was embedded in diffuse adenomyomatous infiltration. The lesion was entirely intramural, and the surface endometrium was atrophic and not neoplastic. The absence of endometrial involvement led to a 6-year delay before hysterectomy was carried out. Pathologic study of the radically excised uterus showed evidence of metastasis to one paraaortic lymph node. Since this appears to be the first example of such an event, the English literature was reviewed for the associated findings of adenomyosis and carcinoma in an intramural setting with noninvolvement of the surface endometrium.

Adenocarcinoma↗
PubMed1987

Gastrointestinal sarcomas. Analysis of prognostic factors.

Clinical and pathologic data from 51 patients with primary sarcomas of the gastrointestinal tract treated from 1951 through 1984 were reviewed to determine clinical presentation, histologic features, treatment, and prognostic factors. The most common signs and symptoms were abdominal pain (62%), gastrointestinal bleeding (40%), and/or abdominal mass (38%). The primary site was stomach in 50%, small bowel in 30%, colorectum in 15%, and esophagus in 5%. Virtually all the sarcomas were leiomyosarcomas. Distribution was uniform among the three histologic grades; although 88% of Grade 1 tumors could be completely excised, only 35% of Grade 3 tumors could be completely resected. The 5-year survival rate was 75% for Grade 1 tumors, 16% for Grade 2 tumors, and 28% for Grade 3 tumors (p = 0.0013, Grade 1 vs. 2 and 3). Thirty of the 51 patients (59%) had curative resection with an operative morbidity rate of 24% and an operative mortality rate of 12%; at 5 years the disease-free survival rate was 58% and the overall survival rate was 63% (48% at 10 years). Eleven patients (42%) had recurrent disease develop at a median interval of 2 years after complete tumor excision. Twenty-one patients (41%) had partial excision or biopsy only of their tumors with an operative morbidity rate of 28%, operative mortality rate of 8%, and median survival of only 9 months. Overall, patients whose tumors were confined to the site of origin had a 58% 5-year survival rate compared with 20% for those whose tumors had invaded adjacent organs (p less than 0.05). If the tumor was less than 10 cm in size, the 5-year survival rate was 78%, significantly better than the 38% for tumors greater than 10 cm (p = 0.03). These data suggest that histologic grade, local invasiveness, size, and extent of resection are the most important prognostic factors for patients with primary gastrointestinal sarcomas. Patients who have resection of all gross tumor, especially if it is well differentiated and localized, have a good prognosis.

Adolescent↗
PubMed1986

Trial of strategy for reducing the use of laboratory tests.

Clinical guidelines and a weekly review of medical records were introduced into a medical unit in a teaching hospital to promote a more discriminating use of laboratory tests. This strategy resulted in an immediate reduction in the average number of requests each week from 74 to 27 haematological tests (64%) and 158 to 58 biochemical tests (64%). During a period of 10 weeks after the strategy was introduced (the intervention period) the mean number of haematological tests for each person decreased from 2.0 during the baseline period to 1.1 (45% reduction; p less than 0.01) and the mean number of biochemical tests decreased from 4.4 to 2.7 (39%; p less than 0.0001). The decrease in the number of repeat requests was greater than that for new requests and accounted for half the reduction in use. There was no significant change in the number of tests requested from an adjacent medical unit that was not exposed to the interventions. This strategy is worthy of trial in other specialties and hospitals, but attention will have to be paid to possible difficulties in sustaining reductions in use over long periods of time.

Clinical Laboratory Techniques↗
PubMed1986

The effect of a novel thromboxane synthetase inhibitor dazmegrel (UK38485) on random pattern skin flaps in the rat.

In the light of work (Emerson and Sykes, 1981) suggesting a protective effect of prostacyclin on the random pattern dorsal skin flap of the rat, the ability of dazmegrel, a novel thromboxane synthetase inhibitor, to protect against ischaemic necrosis in similar flaps has been assessed. No such protective effect could be demonstrated and a possible explanation of the earlier observations is offered.

Animals↗
PubMed1986

Microtubular aggregates within rough endoplasmic reticulum: an unusual ultrastructural feature of extraskeletal myxoid chondrosarcoma.

Two extraskeletal myxoid chondrosarcomas were examined by electron microscopy. In addition to the well-described ultrastructural features indicative of chondroblastic origin, both of these chondrosarcomas had unusual parallel microtubules packed within rough endoplasmic reticulum. This paper reviews the differential diagnosis of extraskeletal myxoid chondrosarcoma and discusses ultrastructural examination as a valuable adjunct in the diagnosis of this uncommon soft tissue tumor.

Chondrosarcoma↗
PubMed1986

Localized primary (AL) amyloid tumor of the breast. Cytologic, histologic, immunocytochemical and ultrastructural observations.

Two examples of localized primary amyloid tumor of the breast are presented, including one patient with metachronous bilateral lesions. Our findings and review of the literature indicate that this rare lesion occurs predominantly in elderly females and can be mammographically and clinically confused with carcinoma. Fine-needle aspiration biopsy can be a useful procedure to make a preliminary diagnosis. Congo red staining with prior potassium permanganate incubation confirmed the AL type of amyloid in our two cases; this might be the predominant type in the localized form involving the breast. Immunofluorescence studies demonstrated IgA, with kappa and lambda light-chain deposition within the amyloid foci in one case, and intracytoplasmic IgG with both light chains within plasma cells and amyloid deposits of the second case. Ultrastructural examination of one of the cases showed characteristic findings of straight, nonbranching fibrils of 4-9 nm, diagnostic of amyloid. From our findings and a review of the literature, we conclude that amyloid tumors of the breast can occur in three separate settings: secondary amyloidosis, systemic or multiple myeloma associated amyloidosis, and as a localized primary type having a benign course.

Age Factors↗