Breast papillomas with atypical ductal hyperplasia: a clinicopathologic study.

Breast papillomas with areas of atypical proliferation reminiscent of ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) are rare, but pose considerable diagnostic difficulty when encountered. The clinicopathologic features of 20 women 27 to 78 years of age with papillomas having atypical proliferations are reviewed. They presented with palpable masses or nipple discharge. Histologically, parts of all lesions had features of papillomas with a biphasic proliferation of benign epithelial cells and myoepithelial (ME) cells. Part of the lesion in each papilloma also had an expansile proliferation of larger uniform cells having evenly spaced, round nuclei and a solid to subtle cribriform growth pattern, similar to ADH or DCIS. These lesions tended to be large, complex or multiple. Twelve patients had 4 to 20 years of follow-up after biopsy only. One each had concurrent and previous contralateral breast carcinoma. Two developed invasive carcinoma of the contralateral breast in 15 and 18 years, respectively. Two developed DCIS on the same side in 2 and 8 years. Six had recurrent papillomas with (5) or without (1) ADH in 1 to 7 years all of whom had no further problems. Only 3 of 12 patients are event free. In contrast, only 8 recurrent papillomas, and 1 ipsilateral invasive carcinoma and 2 contralateral carcinomas occurred in 60 patients with papillomas without ADH in 4 to 18 years. Thus, the patients having ADH within papillomas seem to have greater likelihood of subsequent disease such as recurrences or overt neoplasia, but the length of follow-up and number of patients are not large enough to provide definitive answers. Because none of the patients developed invasive carcinoma on the same side, conservative management with close observation similar to that following a diagnosis of ADH seems to be appropriate.

Idiopathic CD4+ T-lymphocytopenia: analysis of a patient with selective IgA deficiency and no evidence of HIV infection.

Idiopathic CD4+ T-lymphocytopenia (ICL) in HIV-seronegative patients is a newly described, rare entity. The common underlying abnormality is a usually stable depletion in CD4+ lymphocytes in patients, some of which have unexplained opportunistic infections. We present a previously unreported condition of an asymptomatic individual with CD4+ T-lymphocytopenia and a selective IgA deficiency. The subject is a 35-year-old healthy white male with a documented 5-year history of low CD4+ T cell counts. He has been repeatedly HIV seronegative and has no risk factors for HIV infection. Data were obtained from several laboratories over a 5-year period and include standard WBC differentials, HIV testing, serum immunoglobulin quantitation, mitogen stimulation assays, diphtheria and tetanus antitoxin titers, and flow cytometric immunophenotyping. The composite results show a subject with a normal white blood cell count, an absolute lymphopenia, a slight granulocytosis, and a selective IgA deficiency. Leukocyte subset analyses show essentially normal B but significantly altered T cell phenotypes. The normal CD4:CD8 ratio shows extreme inversion, primarily due to CD4 T-lymphocytopenia.

Turn-taking and speech act patterns in the discourse of senile dementia of the Alzheimer's type patients.

Conversational discourse patterns of 11 normal elderly and 11 senile dementia of the Alzheimer's type (SDAT) patients engaged in dyadic interaction with an examiner were examined. Differences in word usage, turn taking, and speech act production were investigated both for the two-subject groups and for the examiner's conversations with each group. Compensatory shifts in discourse by participants are identified. For the subject, differences were shown on words per turn with SDAT subjects speaking in shorter turns and in nonverbal responses with SDAT subjects using this strategy more frequently. Speech act categories of Requestives and Assertives also differed with SDAT subjects using more Requestives and fewer Assertives. The SDAT subjects had significantly more occurrences of unintelligible utterances. For the examiner, words per turn differed with the examiner using shorter turns with SDAT subjects. No differences were shown in the examiner's patterns of speech act usage, nonverbal responses, or intelligibility. In general, these results indicate significant discourse differences in the words per turn level for all participants and speech act levels of conversation for SDAT subjects. They also indicate generally maintained interaction patterns by speakers so that the discourse genre of conversation is sustained. The pattern of compensatory shifts in discourse suggests retained flexibility in the communication system of early and mid stage SDAT patients.

Auditory brainstem responses and clinical follow-up of high-risk infants.

Auditory brainstem response (ABR) evaluations were performed on 667 high-risk infants from an infant special care unit. Of these infants, 82% passed the ABR. Those infants who failed the ABR were classified into two groups, those who failed at 30 dB hearing level and those who failed at 45 dB hearing level. All of the infants were encouraged to return for otologic/audiologic follow-up in 1, 3, or 6 months, depending on the initial ABR results. All of the infants with severe hearing impairments came from the group who failed at 45 dB hearing level. The incidence of severe sensorineural hearing impairment in this population was estimated to be 2.4%. For the group that failed at 30 dB hearing level, 80% of those who were abnormal at follow-up were considered to have conductive hearing disorders and 20% had mild sensorineural hearing impairments. In addition, infants enrolled in a parent-infant program for hearing impaired by 6 months of age were from the ABR program; however, several infants entered the parent-infant program at a relatively late age because they did not meet the high-risk criteria, they were from other hospitals, or they were not detected by the ABR program.

The recovery of vascular changes following brief noise exposure.

Histological measures of cochlear vasculature and blood flow were examined in 20 guinea pigs. Sixteen were exposed to octave band noise at 120 dB SPL for 30 min and then permitted to survive after the exposure for 6 h, 18 h, 48 h, or 4 weeks (N = 4 in each group). Control animals were exposed to the laboratory and apparatus but not to the noise and then sacrificed after 48 h (N = 2) or 4 weeks (N = 2). Statistically significant results indicate that the noise exposure resulted in reduced RBCs in the cochlea for animals permitted to survive 6 to 18 h after the noise exposure. These changes, however, were no longer apparent in animals which were permitted to survive 48 h or 4 weeks after the noise exposure. The vascular sequelae of 30 min exposure to 120 dB octave band noise appear to recover within a few days of the exposure.

The effect of impulse noise on cochlear vessels.

Short- and long-term changes in the cochlear vasculature and long-term changes in the sensorineuroepithelium were studied in guinea pigs after they were exposed to impulse noise. Vessel histology and cochlear hair cell loss were assessed, using a surface-preparation technique, and the results showed considerable variability. Hair cell loss and radial tears in the organ of Corti were a common finding in the animals killed four weeks after impulse-noise exposure. Impulse-noise exposure resulted in few cochlear vascular changes in the acutely and chronically affected groups. Compared with the results of our previous studies using continuous-noise exposure of different characteristics and in different mammals, this impulse-noise experiment resulted in a nonsignificant damaging effect on the cochlear vasculature.

Cochlear hair cell and vascular changes in the guinea pig following high level pure-tone exposures.

Noise is thought to exert metabolic and/or mechanical stress on sensory and vascular tissues of the cochlea, the relative influence of the stressors being influenced by the intensity of the noise. Guinea pigs exposed to either of two pure-tone frequencies, 1.33 or 3.85 kHz for 6 hours at intensity levels ranging from 102 dB to 120 dB SPL, were studied for pathological changes in two spiral lamina vessels--the vessel of the basilar membrane (VSBM) and the vessel of the tympanic lip (VSTL). In general, animals sustaining mild to severe degrees of hair cell destruction one month after noise exposure showed little vascular change in the vessels studied. With respect to the vasculature, the concept of a 'critical level' seems to be dependent on exposure frequency, in that only above 117 dB SPL at 3.85 kHz was there any change in the pattern of damage to the spiral lamina vessels.

Cochlear vascular and electrophysiological effects in the guinea pig to 4 kHz pure tones of different durations and intensities.

Round window cochlear microphonic recordings from 33 guinea pigs were obtained prior to and following exposure to a 4 kHz pure tone at levels ranging from 124 dB to 140 dB for 5 to 80 minutes. When electro-physiological evaluation was complete, the animals were killed and tje cochlear tissues prepared using a soft-surface preparation technique. Experimental and control animals were mixed and randomly assessed without prior knowledge of the groups to which the specimens belonged. Histopathological observations were quantified and computer analysed. Statistical analyses suggest that noise exposure results in an overall decrease in blood flow to the cochlea with slight intracochlear increases in flow, perhaps compensatory in nature, to locations corresponding to the 4 kHz exposed region. Results implied that the initial localized hair cell damage known to occur as a result of overexposure to a discrete pure tone is not caused by a decreased blood flow. Relationships between electro-physiological and vascular changes and noise 'dose' are discussed.

Immediate noise effects on cochlear vasculature in the guinea pig.

Nine guinea pigs were exposed to a 4 kHz narrow band noise at 120 dB for 30 minutes. The animals were killed immediately following exposure and the cochlear tissues prepared using a soft-surface preparation technique. Experimental and control animals were mixed and randomly assessed without prior knowledge of the groups of which the specimens belonged. The results were analysed by computer. Statistically significant differences in the vasculature between noise-exposed and control animals of a general nature included: more changes in spiral lamina than external wall vessels, more changes in vessels facing perilymph than endolymph, and more changes apically than basally. Results indicate slight intracochlear compensations in blood flow, that could potentially maintain a more constant circulation in regions of the cochlea corresponding to the 4 kHz narrow band exposure noise. Methodological aspects of our inner ear vascular technique as well as some hypothetical explanations regarding the observed changes in the blood supply are discussed.

Cochlear vascular histology in animals exposed to noise.

The regularly occurring cochlear vessels in the external wall and spiral lamina were studied in the guinea pig and chinchilla following exposure to various types and durations of noise. A soft-surface specimen technique with or without injection of a contrast medium into the vascular system was used, and the occurrence of specified vascular parameters was assessed using phase-contrast microscopy. Noise does not seem to result in any extraordinary vascular pathology, but a slight, overall decreased blood supply to the cochlea and localized changes depending on cochlear turn are suggested.

The vascular anatomy of the rat cochlea.

The vascular pattern of the rat cochlea was demonstrated by the aid of Berlin Blue (Prussian Blue) contrast. The vascular anatomy is similar to other mammals. The infrequent occurrence of the vessel of the basilar membrane under the organ of Corti is interesting in respect to its presumed importance for the oxygen supply to the hair cells. In the place where the vessel of the basilar membrane usually lies when present, a large uninjected channel was often seen throughout the cochlea. In the external wall, radiating arterioles supply and collecting venules drain all capillary areas. The vascular pattern of the external wall is well maintained at the basal end but is more sparse in apical parts of the cochlea as in other mammals. The rat cochlea is somewhat more difficult to manipulate than the cochlea in other mammals due to its small size, but the dissection of different parts of the cochlea was achieved without major problems.

Some vascular effects of noise exposure in the chinchilla cochlea.

Chinchillas were exposed to pink noise at levels ranging from 110 dB (for 8 h) to 125 dB (for 1/4 h). After a 3-week survival period, the animals were terminated without anesthesia and tissues were prepared using a soft-surface preparation technique [Axelsson et al., Acta Otolaryngol. 80, 362 (1975)]. Cochlear hair cell damage as well as vascular pathology was slight. On occasion, a vessel or vessel segment was obviously atypical, thus allowing noise-exposed animals to be differentiated from their non-noise-exposed controls. More often, however, differences between animals were more discrete and only evident through a computer analysis of the data. The specific effects of these particular noise-exposure parameters on the cochlear blood supply of the chinchilla will be discussed.

Methodological aspects of some inner ear vascular techniques.

Modifications of preparation technique assessing cochlear vasculature together with suggestions regarding their applicability to various types of research projects are presented. Detailed information is given regarding the 'soft-surface' dissection and preparation technique along with selected parameters for evaluating the cochlear vasculature. Some basic requirements for any histological technique studying the inner ear blood supply are suggested.

Vascular histology of the guinea pig cochlea.

Detailed histological findings on all the regularly occurring cochlear vessels in the normal guinea pig are presented. Vessels were examined using a surface prepration technique and phase-contrast microscopy. Particular attention was paid to the density of red blood corpuscles, the thickness of the vascular wall, the occurrence of endothelial cells and pericytes, together with their possible influence on the vessel lumen and the existence of perivascular spaces and vessels lacking blood corpuscles. The data are compared with some previous findings of "vascular pathology" following noise stimulation. The possible functional significance of some of the morphological findings is also discussed.

The effect of high level sound on hearing sensitivity, cochlear sensorineuroepithelium and vasculature of the chinchilla.

Ten young chinchilla were tested for hearing and then exposed for 8 hours to a 110 dB (SPL) broad-band noise. Post-stimulation recovery was assessed daily until permanent threshold shifts were obtained. Cochlear tissues were prepared in order to allow viewing of sensory cells as well as the vascular supply of the cochlea. Findings included inconsistent displacement of the vestibular membrane, poor injection of a contrast medium into vessels, moderate outer hair cell loss and displaced inner hair cell nuclei. Small basal turn cell damage was accompanied by greater than expected losses for high frequency pure tones.