Biomedical subjects
Publications and source records attributed to S Lipper.
Calcospherites are being reported with increasing frequency in pituitary prolactinomas. Ultrastructural study of such a case, along with the recent characterization of the molecular composition of prolactin granules, has led us to hypothesize that a unique intracellular milieu exists in which calcification can be initiated and can proceed to calcospherite formation.
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Congenital inclusion cysts of the subgaleal space in 23 white children are reported. Twenty-two cysts were dermoid and one was epidermoid in nature. The lesions were extracranial and had no intracranial extension. Their location in the subgaleal space was median or paramedian. Their clinical, radiologic, biochemical, and histologic characteristics are detailed and compared with those from Africa. This series counters the motion that such cysts are extremely rare in whites and that the anterior fontanel is their only site of location, as claimed by various authors from Africa.
A clinicopathologic study of 51 patients with endoscopically removed large bowel polyps showing histologic evidence of malignancy, either focally, to a massive extent, or comprising the entire polyp, revealed only one absolute finding capable of predicting residual disease, namely, the presence of cancer at the resection line. Of 23 radical resections, only one was justified. This case showed evidence of residual disease in the colectomy specimen that could have been predicted on the basis of involvement of the diathermy margin by carcinoma. Of 28 patients having polypectomy alone, 1 patient developed a Dukes' B carcinoma. The polyp, removed 9 months previously from the same site, had shown involvement of the margin by carcinoma. A conservative approach is thus advocated in the absence of this finding.
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Few studies have incorporated high-dose methotrexate (MTX) with leucovorin rescue in the treatment of small cell lung cancer (SCLC). Potentially therapeutic levels of MTX can be achieved in the central nervous system (CNS) by systemic administration of high doses of this drug. Utilizing a combination chemotherapy program of Adriamycin, vincristine, cyclophosphamide, and methotrexate, 31 patients were sequentially assigned to receive either low-dose MTX (40 mg/m2), or high-dose MTX (500 mg/m2) with leucovorin rescue. Radiation therapy to the primary site was also administered. At these dosage levels there were no statistically significant differences in response rate or survival between the two groups. High-dose MTX did not prevent the appearance of CNS disease; there being 2/15 and 3/15 CNS relapses in the HD MTX and LD MTX treated groups, respectively. The occurrence of CNS disease did not significantly affect overall survival as compared to patients not similarly affected.
Skeletal adamantinoma is a rare malignant bone tumor with a poorly understood histogenesis. The lesion is easily recognized by a distinctive microscopic pattern of anastomosing trabeculae of epithelial-like cells in a fibrous stroma. Ultrastructural evidence has been presented to support an origin from two widely-divergent cell types: an epithelial cell with squamous characteristics [12, 15] and a mesenchymal cell with endothelial features [5, 9]. An addition to the histogenetic controversy has been the recent description of a bone neoplasm with an adamantinoma-like growth pattern which proved both by subsequent histological evolution and ultrastructure, to have features of Ewing tumor [10]. The authors report a further example of this entity and suggest that it may be sufficiently distinctive within the adamantinoma group to merit the term Ewing-like adamantinoma. Consonant with increasing evidence supporting the concept of tumor "metaplasia" that transcends traditional concepts of epithelial-mesenchymal immutability, the authors propose that all adamantinomas arise from a common stem cell.
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Chondroid chordoma is an unusual tumor composed of an admixture of chondromatous and chordomatous tissue usually located in the spheno-occipital region. This tumor shares many of the clinical and histologic features of classic chordoma and chondrosarcoma and has been shown to have a better prognosis than either of these lesions. To the best of our knowledge, no ultrastructural studies have been performed in the 26 cases of chondroid chordoma published previously. We document the ultrastructural features of two examples of chondroid chordoma. Certain features such as prominent and dilated rough endoplasmic reticulum, intracytoplasmic glycogen aggregates, and abundant fibrillogranular matrix are common to chordoma, chondrosarcoma, and chondroid chordoma. The presence of well-formed tonofilament desmosome complexes as well as complexes composed of alternating profiles of rough endoplasmic reticulum and mitochondria were seen only in chordoma and chondroid chordoma, but not in cartilaginous tumors. Of particular interest was the finding of crystalline, tubular structures within the rough endoplasmic reticulum of both cases of chondroid chordoma, a finding not described previously. The distinction of chondroid chordoma from classical chordoma is said to be a difficult one at the light-microscopic level, and we suggest that these intraergastoplasmic tubular structures might constitute an extremely helpful differential marker.
The occurrence of behavioral disturbances during four-week treatment of depressed patients with the nonselective monoamine oxidase (MAO) inhibitor, phenelzine sulfate (N = 14), the selective MAO-type A inhibitor, clorgyline (N = 12), and the partially selective MAO-type B inhibitor, pargyline hydrochloride (N = 13), was studied. Behavioral disturbances were encountered during treatment with each of the MAO-inhibiting drugs, with an overall incidence of 15% (six of 39 patients). All but one episode met criteria for mania or hypomania. Patients with bipolar illness experienced significantly greater incidences of behavioral disturbances in comparison with patients with unipolar illness (35.3% v 4.5%, respectively). The earliest latency to onset of a behavioral disturbances was 18 days, whereas the mean latencies were 22 to 26 days. Episodes of hypomania were observed after discontinuation of drug treatment in individual patients with unipolar and bipolar illness. Repeated MAO-inhibitor treatment, as part of a crossover study of clorgyline and pargyline, produced an increased severity of behavioral disturbances and a significantly shortened latency to onset.
The effects of 4 weeks of treatment with the selective monoamine oxidase (MAO) inhibiting antidepressant clorgyline and pargyline on the sleep of affectively disordered patients were studied. Both inhibitors resulted in near total suppression of REM sleep, a decrease in total sleep time, and an increase in the percent of stage 2 sleep. Clorgyline also increased awake time and decreased total recording period and sleep latency. In general, changes were greater for clorgyline than for pargyline and were about 50% slower to return to baseline after clorgyline compared to pargyline discontinuation. The results were consistent with the hypothesis that selective inhibition of the MAO type A, as produced by clorgyline, is sufficient to induce marked sleep changes. MAO inhibitor-induced receptor changes are proposed to account for the time course of the REM suppression and the REM rebound observed upon withdrawal.
A case of chronic granulomatous disease of childhood was first diagnosed when a 20-month-old infant developed gastric outlet obstruction. Because of the unusual clinical presentation and negative gastric mucosal biopsies, the diagnosis was delayed. A subsequent full thickness biopsy of the stomach wall which led to a correct diagnosis showed a granulomatous infiltrate in the muscularis propria. Characteristic yellow pigment-laden macrophages were seen in the gastric mucosa and pyloric lymph node. Early recognition of this chronic disorder is important not only for proper management but genetic counseling as well.
The authors found that patients with major affective disorder had higher levels of plasma norepinephrine and higher pulse rates (tachycardia) than healthy control subjects, but their blood pressures were normal. These measurements were similar in all three subgroups of patients with affective disorder--manic, bipolar depressed, and unipolar. Because norepinephrine is the primary neurotransmitter of the sympathetic nervous system, these data suggest sympathetic hyperactivity in the major affective disorders. This conclusion is compatible with recent speculation based on the effect of antidepressants on noradrenergic receptors and a failure of alpha-receptors to downregulate normally in patients with major affective disorder.
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An ultrastructural study of three cases of hemangiopericytoma showed cells partially or completely enveloped by well-formed basement membrane and basement membrane-like material. The cells exhibited prominent cytoplasmic filaments, some showing dense body formation, interdigitating cytoplasmic processes, and pinocytotic vesicles. A review of the literature revealed only 19 other cases of hemangiopericytoma studied by electron microscopy, and these included seven cases of meningeal origin ("angioblastic meningioma"). The most consistent feature seen in all but two cases was the presence of a basal lamina or basal lamina-like material either partially or completely surrounding tumor cells and separating endothelial cells from pericytes. The light microscopic diagnosis of hemangiopericytoma is difficult, and there is a tendency to append the diagnosis to a variety of other tumors with a prominent vascular pattern in which other specific diagnoses are not immediately evident. The presence, ultrastructurally, of well-developed basement membrane, myogenic type filaments, and pinocytotic vesicles in a tumor with light microscopic features suggestive of hemangiopericytoma would consolidate the diagnosis and usually eliminate diagnostic uncertainty.
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A 62-year-old woman developed a recurrent mucinous sweat gland adenocarcinoma of the eyelid. The clinical characteristics of this rare, primary adnexal neoplasm of skin in our patient were, to our knowledge, unique. The tumor mimicked a lacrimal sac tumor and had orbital extension demonstrated preoperatively by computed axial tomography. Orbital extension of the tumor mass was confirmed during a wide, en bloc, excisional biopsy.
A 37-year-old man underwent an enucleation of his left eye because of a lesion that demonstrated the clinical and fluorescein angiographic characteristics of a malignant melanoma. Histologic examination of the eye disclosed a chorioretinal inflammatory mass caused by refractile crystalline material.