Liability issues with the Papanicolaou smear: the expert witness database.
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Expert Testimony↗
Biomedical subjects
W S Wood
Publications and source records attributed to W S Wood.
Pyodermatitis-pyostomatitis vegetans: a specific marker for inflammatory bowel disease.
In pyodermatitis-pyostomatitis vegetans annular pustular cutaneous lesions may precede, accompany, or follow the usually extensive vegetating oral disease. Sometimes only cutaneous or only oral lesions occur and previously have been described as separate entities. Clinical, histopathologic, and immunopathologic evidence clearly indicates this is one disease and suggests that it is distinct from pemphigus vegetans. The association between pyodermatitis-pyostomatitis vegetans and inflammatory bowel disease, most commonly ulcerative colitis, has been amply confirmed. Pyodermatitis-pyostomatitis vegetans should be considered a marker for inflammatory bowel disease.
Adolescent↗
Oral pemphigus vulgaris associated with inflammatory bowel disease and herpetic gingivostomatitis in an 11-year-old girl.
An 11-year-old girl with recently diagnosed oral pemphigus vulgaris developed a severe exacerbation of mouth ulceration due to superinfection with herpes simplex virus type I. A concurrent diagnosis of chronic inflammatory bowel disease was established to explain symptoms of weight loss and intermittent bloody diarrhea that predated the oral ulceration by several years. Herpes simplex infection is a recognized complication of pemphigus vulgaris that may be mistaken for a recrudescence of the disease. The association of pemphigus with chronic inflammatory bowel disease has been documented in a small number of adults. Its relationship to pyostomatitis vegetans, an acknowledged marker for ulcerative colitis and Crohn disease, remains unclear.
Child↗
An ulcerated plaque in a gay man. Cutaneous cryptococcosis.
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Adult↗
Eccrine syringofibroadenomatosis: a clinical and histologic study and review of the literature.
A 56-year-old man had an 11-year history of a psoriasiform eruption of the palms, soles, and shins. An examination revealed well-demarcated patches and plaques of erythematous, fissured, and hyperkeratotic skin with focal erosions. There was no clinical evidence of ectodermal dysplasia. On histologic examination these lesions proved to be eccrine hamartomas that consisted of anastomosing cords and strands of cuboidal epithelial cells with well-formed ducts and a fibrovascular mucinous stroma. Eccrine ductal origin was indicated by histopathologic, histochemical, immunopathologic, and electron microscopic evaluation. These multiple palmoplantar eccrine hamartomas, unassociated with ectodermal dysplasia, represent a sporadic hamartomatous condition that is best designated as "eccrine syringofibroadenomatosis."
Adenofibroma↗
Analysis of HMB-45 immunoreactivity in common and cellular blue nevi.
HMB-45 is generally thought of as a melanoma specific antibody; however, there are certain exceptions. It is known that most dermal nevi show no reactivity; however, the dermal nevus component within dysplastic nevi and certain Spitz nevi show positive reactivity. In order to further examine this observation, we undertook a study to examine blue nevi, both common and cellular, for the expression of HMB-45. Cases were stained with antibodies directed at both HMB-45 and S100 protein. Of 16 common blue nevi studied, 14 were positive with HMB-45, as were 6 of 6 cellular blue nevi. Staining for HMB-45 was quite variable in intensity amongst cases labelled common blue nevi. In contrast, cellular blue nevi were uniformly strongly positive. It is therefore concluded that blue nevi, including cellular blue nevi, exhibit an activated phenotype as demonstrated by HMB-45 reactivity.
Antibodies, Monoclonal↗
Pathologic prognostic factors for cutaneous malignant melanoma: the Western Canada Melanoma Study.
An analysis of data for histopathologic factors influencing survival was conducted on 798 cases of invasive cutaneous malignant melanoma. On univariate analysis, a number of factors influenced survival; however, when these factors were examined using a proportional-hazards model, sex and log of depth of penetration were the only factors governing survival. Moreover, these factors were only important in patients with lesions up to 4 mm in depth with no evidence of other disease. For patients with solitary lesions deeper than 4 mm, or patients with regional or distant disease, none of the factors examined in our study was of predictive value for survival assessment.
Adult↗
Trichoblastic fibroma. A clinicopathologic study of three cases.
Three cases of trichoblastic fibroma, a rare benign skin tumor of hair follicle origin, are reported. On clinical examination, solitary, mobile, subcutaneous nodules with normal overlying skin were found on the vulva (one case) and scalp (two cases) in women aged 57, 46, and 19 years, respectively. On microscopic examination, the tumors were composed of complex nests and strands of basaloid, focally keratinized epithelium arranged in a moderately cellular fibroblastic stroma. No connection with the overlying epithelium or adjacent adnexal structures was observed. Immunohistochemical staining supported a trichogenic origin for these tumors. Trichoblastic fibromas are histologically distinctive lesions that should be distinguished from other tumors of follicular origin and from keratotic basal cell carcinoma.
Adult↗
Lupus profundus presenting as thrombophlebitis.
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Adolescent↗
Mammary Paget's disease and intraductal carcinoma. Histologic, histochemical, and immunocytochemical comparison.
This study of mammary Paget's disease was carried out with the objects of clarifying its histogenesis and of determining optimal diagnostic measures. Ten consecutive cases of mammary Paget's disease with their underlying ductal carcinomas were compared. Histologic, histochemical, and immunocytochemical examination mainly supported the hypothesis that mammary Paget's disease is an extension of mammary ductal carcinoma into the overlying nipple epithelium. However, two of our ductal carcinomas stained strongly with S-100 protein, while Paget's disease was uniformly negative with this antibody. The significance of this finding is not known. Optimal diagnostic accuracy is obtained by using a combination of routinely stained sections along with a panel of immunocytochemical stains. Nipple wedge biopsy may demonstrate both intraduct carcinoma and Paget's disease, and is thus a superior biopsy technique.
Biopsy↗
Etiological differences between subtypes of cutaneous malignant melanoma: Western Canada Melanoma Study.
From newly incident cases in Western Canada, 415 patients with superficial spreading melanoma (SSM), 128 with nodular melanoma (NM), and 56 with lentigo maligna melanoma (LMM) were interviewed, with age- and sex-matched controls chosen from the general population. The associations of these 3 subtypes with pigmentation, skin reaction to sun, different types of sun exposure, sunburn, and suntan were assessed. Compared to the other types, LMM occurred in older patients, and 75% of lesions occurred on the head and neck: It was less strongly related to pigmentation factors, intermittent sun exposure, and skin reaction to sun. The associations of SSM and NM with pigmentation, chronic sun exposure, skin reaction, and suntan were very similar: Both were associated with intermittent sun exposure, but SSM was more strongly related to vacation exposures than was NM. These results were compared with those from a similar Australian study. While LMM appears different in its etiology from SSM and NM, there is no strong evidence of major etiological differences between SSM and NM.
Adult↗
Niemann-Pick disease and juvenile xanthogranuloma. Are they related?
Niemann-Pick disease is a rare autosomal recessive lipidosis with accumulation of sphingomyelin in multiple organs due to sphingomyelinase deficiency. Cutaneous lesions are uncommon. We describe a case of Niemann-Pick disease with multiple cutaneous papules and nodules resembling juvenile xanthogranuloma.
Diagnosis, Differential↗
Secondary enuresis associated with hyperthyroidism.
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Adolescent↗
Femoral neck fractures in the geriatric population: the influence of perioperative health upon the selection of surgical treatment.
The use of a primary prosthetic replacement such as an Austin-Moore hemi-arthroplasty in patients sustaining fractures of the femoral neck has been associated with increased post-operative medical morbidity and mortality. A retrospective review was performed using the medical records of patients greater than 59 years of age who sustained femoral neck fractures and were treated with either internal fixation or primary hemi-arthroplastic replacement at Loyola University Medical Center between 1969 and 1979. Peri-operative data were reviewed and evaluated using computer-aided statistical analysis. Comparing the two forms of surgical treatment, statistically significant factors associated with primary hemi-arthroplastic replacement included: pre-injury nursing home residence, pre-injury ambulation requiring assistance, age greater than 79 years, slight elevation in serum creatinine values, abnormal electrocardiograms in patients over 77 years of age, time from injury to surgery of four or more days, and the use of spinal anesthesia (P less than 0.05). Factors associated with internal fixation were: patient age of 79 years or less, independent ambulation, non-nursing home residence, normal lab values, normal EKGs, less than four days from injury to surgery, and the use of general anesthesia. Within the limits imposed by a retrospective review in this specific patient population, there appears to be a tendency for older, less healthy patients to have been treated with primary hemi-arthroplasty. Possibly the previously reported increased post-operative medical morbidity and mortality associated with this procedure, as compared with internal fixation, may be a result of biased patient selection, and not a fault of the procedure.
Age Factors↗
Tumors of ceruminous glands.
Tumors of the ceruminous glands may involve the auricular and preauricular skin and thus should be included in the differential diagnosis of neoplasms involving these areas. A rational decision as to the management of ceruminous gland tumors depends on the precise histologic classification of these tumors and the extent of involvement. We present seven patients with tumors of the ceruminous glands: ceruminous adenoma in one, ceruminous adenocarcinoma in three, and adenoid cystic carcinoma in three. The literature is reviewed with respect to signs and symptoms, pathology, and therapy.
Adenocarcinoma↗
Correlation of morphologic and biochemical observations in human lipomas.
Our studies of 107 patients with 133 lipomata showed that the male to female ratio for single lipoma was 1.2:1, and for multiple lipoma it was 3.5:1. More than 40% of the men and 30% of women with multiple lipoma had a family history of lipoma. Specimens from 23 patients were analyzed for lipid and protein content. Adipose tissue from lipoma had somewhat more lipid per gram of wet weight than adjacent normal tissue (75.0 versus 72.8%) or 16 additional control adipose tissue samples, from patients undergoing elective abdominal surgery (71.5%), but the differences were not statistically significant (p = 0.085). There were no differences in protein content. In 13 men the lipoprotein lipase activity of lipoma was markedly higher compared with the adjacent normal adipose tissue (40.4 +/- 15.5 versus 14.0 +/- 11.7 nmoles/gm/minute at 37 degrees C, p = 0.001) or to control adipose tissue (9.6 +/- 7.2 nmoles of free fatty acid/gm/minute at 37 degrees C, p = 0.001). It is likely that the high lipoprotein lipase activity of lipoma contributes to the growth of the tumor. Morphologically, there were no clear distinguishing features between the adipocytes of lipoma, adjacent normal adipose tissue, or control adipose tissue. However, the numbers of more immature type or preadipocytes (mesenchymal cells) appeared to be more numerous in lipomata compared with the control tissues. No differences in immunologic reactivity could be detected using antisera to fat cell membranes from lipoma or control adipose tissue.
Adipose Tissue↗
Experimental intraabdominal abscess formation by Escherichia coli and bacteroides fragilis.
An improved animal model of intraperitoneal abscess formation was developed in order to study the role of Bacteroides fragilis and Escherichia coli. Both microorganisms were found to independently cause abscesses, although Bacteroides fragilis-induced abscesses were invariably minute. The combined inoculation of these microorganisms resulted in the induction of intraabdominal abscesses larger than those formed by Bacteroides fragilis or Escherichia coli alone. However, the size difference between abscesses produced by Escherichia coli alone and by the combination of both organisms was not statistically significant. The animal model defined in this study differed from earlier models in that use of the complex sterile cecal contents can be avoided. This allows for a more precise evaluation of the contribution of each organism to the pathogenic process of intraabdominal abscess formation.
Abdomen↗
Congenital multiple fibromatosis.
We present a case of congenital multiple fibromatosis to illustrate its characteristic clinical and histopathologic features. The importance of recognizing this disorder is emphasized because of its special clinical behavior and prognosis.
Fibroblasts↗