The five-year evaluation of a mechanical heart valve without anticoagulation in goats.

Two 5-year observations of goats with microporous surfaced Björk-Shiley Monostrut mitral heart valves without anticoagulation show the important point that one went through four the other two normal pregnancies with delivery of fourteen kids. Furthermore, the local findings on the valves suggest that the porous surface should be used only to invite a thin, endothelialized neointima over a preferably carbon-coated suture ring to continue over the groove and to the adjacent part of the valve flange. The vertical or central part of the ring and the struts, in the control material with a polished surface, have never been the origin of a thrombus and should therefore be polished.

Bronchilar carcinoma in a 20-year-old man.

A 20-year-old man with a nine-month history of pulmonary abscess and hemoptysis was discovered to have a small nidus of bronchiolar carcinoma in the fibrotic reaction surrounding the pulmonary abscess. The cell type, origin, and occurrence of this tumor in fibrotic pulmonary disease are discussed. We believe that this case represents an unusual presentation of bronchiolar carcinoma with respect to clinical manifestation, tumor size, and patient's age.

The porous metal-surfaced heart valve. Long-term study without long-term anticoagulation in mitral position in goats.

On review, all thromboembolic complications in mechanical heart valves start from a thrombus lining that covers the suture ring. The thrombus organizes to a fibrous white sheet over the suture ring, which then can protrude out over the polished surface of the valve ring flange. Pieces of the thrombus can be knocked off by the disc and cause emboli. To diminish thromboembolic complications, one must either prevent this thrombus from protruding into the groove between the suture ring and the valve flange or allow the thrombus to be organized as a thin covering with endothelium-like cells as a continuation from the suture ring over the valve flange. This type of covering was obtained during a short period of anticoagulation by applying a microporous surface to the Björk-Shiley Monostrut mitral valve. These valves were implanted in one set of goats and the conventional Björk-Shiley Monostrut mitral valve, with a polished surface, in another set of goats (control group). The two groups were then compared with regard to the incidence of thromboembolic complications encountered during 1 year's follow-up without anticoagulation. The goats were put to death and examination revealed the following observations: In the control group, (1) a varying amount of thrombus formation was found in the groove between the suture ring and the flange in all nine goats and (2) thrombus formation did not start on the polished struts or discs in any of the nine goats. In the group with the microporous Monostrut mitral valve, 19 animals were put to death and examined: (1) The endothelialized covering over the suture ring, thinner when carbon coated, continued over the microporous flange, tapering off in the center of the orifice in all 19 valves on the ventricular side and in 14 of the 19 valves on the atrial side; (2) the center of the orifice and the struts were never completely covered by endothelialized tissue because of high flow; (3) there was an increased incidence of small thrombus formation on the disc-contacting microporous surface of both inflow and outflow struts. Therefore these surfaces should not be coated but left polished.

Colposcopic evaluation of cervical intraepithelial neoplasia.

Colposcopic examination and directed biopsies were performed on 70 patients with abnormal cerivcal cytology. The correlation of the histology of the directed biopsies with the colposcopic appearance was 80%; it was 86% with the original Papanicolaou smear. In no case was the histology of a subsequent cone biopsy or hysterectomy specimen more advanced than that of the directed biopsy. Conization was avoided in 52 of the 70 patients and could have been avoided in seven others.

Aspiration biopsy in the context of the new Medicare fiscal policy.

The new Medicare legislation requires hospital reimbursement on a per case, rather than cost per test, basis. This policy emphasizes selectivity in hospitalization, increased efficiency in diagnosis and therapy and abbreviated hospital stays. Aspiration biopsy is discussed as a procedure that responds to needs stimulated by fiscal demands, with particular attention given to cost containment and outpatient care and aspiration biopsy's value as a vehicle that ensures high-quality medical care.

Asbestos bodies in fine needle aspirates of the lung.

Asbestos bodies, which are the hallmark of exposure to asbestos, were identified in cytologic preparations from fine needle aspirates of the lung in two individuals, one with considerable occupational exposure to asbestos and one for whom no source of asbestos exposure could be identified. At autopsy, large numbers of asbestos bodies were identified in the lung parenchyma in each case by use of a quantitative hypochlorite digestion-concentration technique. Scanning electron microscopy and energy-dispersive x-ray analysis demonstrated that the main types of asbestos present were the commercial amphiboles, amosite and crocidolite. We have rarely identified asbestos bodies in fine needle lung aspirates studied in our laboratories and are not aware of such reports in the literature. It is likely that the identification of asbestos bodies in fine needle aspirates of the lung is indicative of considerable occupational exposure to asbestos.

Giant condyloma acuminatum (Buschke-Loewenstein tumor) of the anus: case report and review of the literature.

The fifth patient with anorectal giant condyloma of Buschke and Loewenstein is reported. Review of the world literature is presented with a summary of previous case reports. The malignant behavior of giant condyloma is emphasized. Successful local extirpation without abdominoperineal resection can be peformed when indicated.

Bronchiolar carcinoma: report of 11 cases and review of the literature.

Eleven cases of bronchiolar carcinoma seen between 1970 and 1975 are reviewed. Roentgenographic manifestations at the time of initial examination included single peripheral nodules, multiple nodules, irregular cavities and a persistent infiltrative form. Microscopic tissue examinations showed two patterns of tumor growth: a papillary form resembling tall columnar cells extending along but not invading the alveolar septal walls and a cribriform pattern represented by inflammatory thickening of the alveolar septal walls and pleomorphic cellular proliferation within luminal spaces. The papillary form was associated with the cavitary lesions. Long term survival is dependent on early recognition of the single peripheral nodule, cavity or small persistent infiltrative form managed by a thoracotomy and lobectomy.

Modified porous metal-surfaced Björk-Shiley monostrut heart valve. Long-term study in goats without anticoagulation.

To diminish the risk of thrombosis on a mechanical heart valve without anticoagulation, specific areas of the valve ring should be polished, as thrombosis has not been found to start there. By limiting the porous-surfaced area to the groove and the adjacent part of the flange, the thin endothelialized covering of the carbonized suture ring will continue over the groove and top of the flange to the high-flow area. As the high-flow areas that are not completely covered with the neointima, i.e. the struts and the vertical or central portion of the valve ring, are at increased risk of bacterial invasion if their surface is porous, they should be left uncoated and polished.

Optimal microporous surface for endothelialization of metal heart valves in the blood stream.

Optimum surface porosity of a prosthetic heart valve was obtained with use of microspheres less than 40 microns in diameter. A thin and translucent neointima then forms on the valve surface, so thin that its nutrition is supplied by diffusion and thickening will not take place, thereby avoiding interference with the functioning disc. Larger microspheres tend to promote clotting and buildup of fibromyxoid soft tissue, which may cause such interference.

Histologic conversion of an unfavorable primary brain lymphoma to a favorable type.

Histologic conversion of a less aggressive non-Hodgkin's lymphoma to a more aggressive type has been established in several studies. Neither this trend nor vice versa has been reported in primary brain lymphoma, because of the poor median survival in the clinical setting which precludes further invasive procedures. The authors report a case of transformation of a primary brain lymphoma, histiocytic type, to poorly differentiated lymphocytic lymphoma 2 1/2 years after treatment with radiation and intrathecal methotrexate.

DNA quantification in colorectal carcinoma using flow and image analysis cytometry.

Numerous studies using flow cytometry (FCM) have shown that DNA quantification and ploidy classification can provide information of prognostic significance for patients with colorectal carcinoma; recent advances in image analysis cytometry (image cytometry, ICM) provide a new, alternative technique for DNA quantification. This study investigated whether (1) patients with colorectal carcinomas that exhibit a diploid pattern of DNA distribution have improved five-year survival statistics as compared to their non-diploid counterparts and (2) ICM provides quantitative data comparable to that obtained by FCM. DNA quantification and ploidy classification of 27 cases of primary colorectal carcinoma was performed on archival paraffin-embedded tissue by both FCM and ICM; 70% (19) of the tumors were classified as nondiploid by ICM while 56% (15) were similarly classified by FCM. Diploid tumors were associated with Dukes' stage A while nondiploid tumors were associated with Dukes' stage D. The overall five-year survival rate was 75% for patients with ICM diploid tumors and 67% for patients with FCM diploid tumors. The five-year survival was only 53% for patients with nondiploid tumors identified by both techniques. This study confirmed that DNA quantification is an important prognostic indicator for patients with colorectal carcinoma. It also showed that ICM provides data comparable to that of FCM and may be more sensitive.

Medullary carcinoma is associated with expression of intercellular adhesion molecule-1. Implication to its morphology and its clinical behavior.

The histological hallmarks for the diagnosis of medullary breast cancer are circumscription, syncytial architecture, diffuse inflammatory infiltrate, and highly atypical nuclei. The biological and prognostic implication is a lower propensity to metastasize. We studied 19 medullary carcinomas for expression of the intercellular adhesion molecule-1 and lymphocyte-function-associated antigen-1, Neu differentiation factor, tumor necrosis factor-alpha, and the expression of HER-2/neu, HER-4, and HER-3 receptors. Our study revealed that all of the 19 medullary carcinomas expressed the intercellular adhesion molecule-1 and lymphocyte function associated antigen. Eighteen of 19 cancers expressed Neu differentiation factor and tumor necrosis factor-alpha. All medullary cancers expressed the HER-2/neu receptor, however, in the majority of the cases, the staining was confined to the cytoplasm. Only 4 of 12 cancers expressed HER-4 and none of the eight medullary cancers tested expressed HER-3. By comparison, in a control group of infiltrating ductal carcinomas, expression of intercellular adhesion molecule-1, lymphocyte function associated antigen-1, and Neu differentiation factor was positive in about 25 to 30% of the cases, HER-4 was expressed in 75% and HER-3 in 95% of the cases. Taken together, our observations suggest that the expression of intercellular adhesion molecule-1, lymphocyte function associated antigen, Neu differentiation factor, and tumor necrosis factor-alpha as factors that may affect the special morphology and the biological behavior that characterizes medullary carcinomas.