Biomedical subjects
Publications and source records attributed to T S Talamo.
A 31-year-old woman presented with constant epigastric pain. Obstruction of the pancreatic duct was observed by ultrasonography and CT scan and was further defined by ERCP. Surgical exploration of the pancreas revealed a tumor in the pancreatic head. Histologic and immunocytochemical examination revealed a benign granular cell tumor, a neoplasm not previously described as causing obstruction in the pancreas.
Budd-Chiari syndrome and constrictive pericarditis share many clinical and histologic features. Clinicians must continue to reassess patients when given histologic data that are not specific for a particular disease entity, so that subtle clinical differences are recognized, appropriate diagnosis made, and therapy instituted.
Two cases of endocarditis secondary to permanent indwelling catheters are described. In both cases, the catheters were used for parenteral nutrition and became infected with Staphylococci. Secondary endocarditis developed on the tricuspid and aortic valves. Despite removal of the catheters and appropriate antibiotics, both patients died.
This report describes two patients with acquired immune deficiency syndrome (AIDS) in whom respiratory failure and opportunistic infection associated with secondary alveolar proteinosis developed. In one patient, the alveolar proteinosis was apparently secondary to Mycobacterium tuberculosis and in the other to Pneumocystis carinii and cytomegalovirus infection. Both patients died of respiratory failure, and it was suspected that secondary alveolar proteinosis could have been a contributing cause of death.
A 40-yr-old woman with celiac sprue, which had responded clinically and histologically to gluten elimination, subsequently developed gastrointestinal lymphoma. Although this has been described in the small intestine of patients with celiac sprue, the unique feature in this patient was her initial presentation with multiple gastric ulcers refractory to conventional medical therapy. This case demonstrates that lymphoma complicating celiac sprue may present with multiple refractory gastric ulcers in addition to those occurring in the small intestine.
The treatment of scalp wounds is occasionally complicated by infection. Although infected scalp wounds are generally limited and readily treated, they can progress to devastating proportions if not promptly and aggressively managed. This report highlights three such cases of severe infection: extensive subgaleal abscess, fatal necrotizing fasciitis, and widespread carbunculosis. The authors emphasize the need for proper assessment of scalp wounds, meticulous cleansing and closure of all fresh wounds, definitive drainage of newly infected wounds, and adherence to sound surgical principles in managing these wounds.
The authors have developed a microcomputer-based system for interpretative reporting of sequential cardiac profile data, which consists of creatine kinase and lactate dehydrogenase isoenzyme levels. Patient demographic data and test results (total creatine kinase [CK], MB isoenzyme of CK [CK-MB], lactate dehydrogenase isoenzyme 1 [LD-1], and lactate dehydrogenase isoenzyme 2 [LD-2]) are entered manually through the keyboard. Percent MB and LD ratio are calculated. The test results are compared with normal range values, and an interpretative report is generated, including all pertinent demographic information and graphic display of up to 36 previous CK and LD isoenzyme determinations. Interpretative statements are printed beneath the graphic display after analysis of previous test results. The combination of graphic data display and interpretations based on prior data provides useful and accurate information to the cardiologist. Significant discrepancies between computer-assisted and pathologist interpretation were not encountered.
Ventriculoperitoneal shunt metastases from primary intracranial germinomas are extremely rare. To date, only three case reports of this phenomenon have appeared in the literature. We present the case of a 25-year-old black male who developed ventriculoperitoneal shunt metastases 10 months following diagnosis of an intracranial germinoma. Radiotherapy destroyed most of the intracranial tumor, but abdominal metastases became progressive and were not treated with radiotherapy. The role of radiotherapy in the treatment of ventriculoperitoneal shunt metastases is examined and previous cases in the literature are reviewed.
Eleven potential biochemical markers were measured in serum from 33 patients with malignant and 13 with benign colorectal disease: four isoenzymes (creatine kinase-BB, homoarginine-sensitive alkaline phosphatase, salivary-type amylase, and macro-creatine kinase type 2), five specific proteins (ferritin, alpha 1-acid glycoprotein, C-reactive protein, alpha 1-antitrypsin, and ceruloplasmin), one oncofetal antigen (carcinoembryonic antigen, CEA), and one hormone (beta human choriogonadotropin). The sensitivity of individual markers for the detection of early-stage malignancy (n = 11) ranged from 0% to 64% (CEA 18%); for late-stage colon malignancy (n = 12) from 8% to 83% (CEA 83%). Specificity in patients (n = 10) with benign intestinal disease ranged from 80% to 100% (CEA 100%). The five most-sensitive markers--C-reactive protein, alpha 1-glycoprotein, CEA, macrocreatine kinase type 2, and homoarginine-sensitive alkaline phosphatase--were selected for use as a "colon panel." In retrospective comparison, use of the colon panel instead of CEA alone increased sensitivity by 17% and 64% for late-and early-stage cancer, respectively; specificity, however, decreased by 30%, but should improve with serial testing.
We have developed an inexpensive, microcomputer-based, multiuser hard disk system for surgical pathology that uses a commercially available word processor and data base manager, linked together by several BASIC programs written by us. System functions include keyboard input of patient demographic data and specimen information, word processing with the generation of preliminary and final surgical reports, on-line access to the surgical pathology data base, generation of daily secretarial and histology log sheets, and computer-assisted SNOMED coding. Successful implementation of this system has produced greater efficiency and productivity in the surgical pathology department at a reasonable cost.
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A case of fallopian tube adenocarcinoma was studied by light and transmission electron microscopy. The neoplastic cells contained abundant mitochondria, moderate to large amounts of rough endoplasmic reticulum (RER) arranged in parallel arrays and often containing amorphous material, annulate lamellae, possible secretory vesicles, and glycogen. The presence of stacked RER and annulate lamellae together is unusual in papillary serous cystadenocarcinoma of the ovary, and has not been described in Fallopian tube adenocarcinoma. Golgi complexes were are. Small acini with projecting microvilli as well as junctional complexes were present, but cilia were not found. The electron microscopic findings suggest secretory activity, and are remarkably similar to those found in papillary serous cystadenocarcinomas of the ovary. The findings also support the hypothesis that ovarian serous tumors and adenocarcinomas of the Fallopian tube are derived from coelomic epithelium.
A microcomputer based system for interpretative reporting of protein electrophoretic data has been developed. Data for serum urine, and cerebrospinal fluid protein electrophoreses as well as immunoelectrophoresis can be entered. Patient demographic information is entered through the keyboard, followed by manual entry of total and fractionated protein levels obtained after densitometer scanning of the electrophoretic strip. Protein patterns are coded, interpreted, and final reports generated. In most cases, interpretation time is less than one second. Computer misinterpretation is uncommon and easily corrected by edit functions within the system. Discrepancies between computer and pathologist interpretation are automatically stored in a separate data file for later review and possible program modification. Any or all previous tests on a patient may be reviewed, with graphic display of the electrophoretic pattern. The system is well-accepted by the laboratory staff, and allows rapid storage, retrieval, and analysis of protein electrophoretic data.
A 63-year-old white man had simultaneous onset of the Guillain-Barré syndrome and the nephrotic syndrome, three weeks after having an upper respiratory tract infection. Many granular casts were noticed in the urine sediment. Renal biopsy specimens showed early membranous glomerulonephritis and acute interstitial nephritis by light microscopy, with fine granular deposition of IgG, IgM, and C3 along the basement membrane by immunofluorescence. Electron microscopy revealed subepithelial electron-dense deposits (Stage 1 membranous glomerulonephritis). The association of these two syndromes is rare, although evidence of immunologic dysfunction has been described in both. The recent literature is reviewed and possible pathogenetic mechanisms are discussed.
A 1,730-g infant with severe caudal regression syndrome (sirenomelia) died shortly after delivery, after a 34-week gestation. Autopsy findings included multiple skeletal anomalies, renal agenesis, amnion nodosum, and a single lower extremity. Postmortem arteriography demonstrated a persistent vitelline artery and documented the vascular pattern within the lower extremity. To our knowledge, angiographic demonstration of the lower limb vascularity has not been described previously in sirenomelia. The angiographic findings support the pathogenetic concept of limb bud fusion and malrotation of the limb in sirenomelia after damage to the posterior axis mesoderm in early embryonic life. Postmortem arteriography is an inexpensive, retrievable, and easy means of documenting vascular anomalies in the fetus or infant with multiple congenital abnormalities.
A microcomputer based program package has been developed which utilizes a modified "average of normals" method to analyze data and monitor random and systematic error in the clinical hematology laboratory. The daily workload of normal patient values for leukocyte count, erythrocyte count, hemoglobin, mean corpuscular volume, prothrombin time, and activated partial thromboplastin time is entered through the keyboard and sorted by sex. The daily mean, standard deviation, standard error index, and F-ratio are then calculated for each test. Significant deviations from target values are automatically flagged. The system combines ease of data input with automatic statistical calculation, graphic display, and printout of the calculated data. The system has the capability of data analysis by shift, and incorporates cumulative sum, Trigg's tracking algorithm, and analysis of variance calculations. This statistical analysis had proven to be a sensitive indicator of random and systematic error in our laboratory and has allowed us to decrease the assay frequency of expensive commercial control material.
A 63-year-old man with acute, heterophil-negative Epstein-Barr (EBV) viral infection displayed neurologic impairment that progressed to coma and death. Fever, pharyngitis, and lymphadenopathy were notably absent. There was no lymphocytosis, and multiple peripheral smears revealed few atypical lymphocytes. Results of specific EBV serology were diagnostic of acute infection. At the time of autopsy, there was massive intravascular and perivascular infiltration of all organs by lymphocytes and atypical mononuclear cells. There was depletion of the paracortical T-lymphocyte areas of lymph nodes. The atypical mononuclear cells did not contain intracytoplasmic immunoglobulin, as shown by the immunoperoxidase technique, nor did they take up esterase stains, but their electron-microscopic features were characteristic of lymphoid cells. These morphologic findings suggest a T-cell defect, with unrestricted proliferation of B lymphocytes. The lack of characteristic clinical and hematologic features in this case underscores the value of specific EBV serology in the diagnosis of acute heterophil-negative EBV infection.
A patient with hepatitis B induced chronic active hepatitis and cirrhosis had hepatocellular carcinoma and poorly differentiated lymphocytic malignant lymphoma localized in the liver. Whereas a close relationship between hepatitis B viral infection, chronic active hepatitis, macronodular cirrhosis, and hepatocellular carcinoma is now recognized, no such association has been reported with primary hepatic malignant lymphoma, which is a distinctly rare entity. In a large autopsy population that we reviewed systemic malignant lymphoma rarely occurred in association with cirrhosis. Such an association has been noted in other studies, however. We speculate half if an association exists between malignant lymphoma and cirrhosis it might have an immunologic basis such as seen in certain autoimmune diseases.