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Biomedical subjects

A E Joseph

Publications and source records attributed to A E Joseph.

At least 19 recordsLinked to original sources
PubMed1995

Casey House: interpreting the location of a Toronto AIDS hospice.

This paper focuses on an overtly geographical issue, the introduction of a housing facility for people living with AIDS (PLWAs) into the urban landscape. Specifically, we critically analyze the location of Casey House, an AIDS hospice in Toronto and presently the only facility of its kind in Canada. Three questions are addressed: (i) how did Casey House come to exist?; (ii) why is Casey House located at the corner of Huntly Street and Isabella Street?; and (iii) will Casey House be reproduced? In our response to the first two questions, we draw selectively upon three perspectives (accessibility, structuralist and humanistic) that have been appealed to in analyses of (controversial) health care facility location processes. In the concluding discussion, three relevant spheres of reproduction are considered: locational, institutional and social. In consideration of the obvious constraints on reproduction, we conclude that the creation and location of Casey House may well be a unique geographical event in Canada.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Case report: intravenous leiomyomatosis, an unusual cause of intracardiac filling defect.

Intravenous leiomyomatosis (IVLM) is a condition characterized by intravenous growth of histologically benign smooth muscle tumour originating in the uterus. Rarely, the tumour can extend via the inferior vena cava into the right side of the heart. In only one previously described case has the tumour extended into the pulmonary artery. We present a second such tumour. In this case, tumour calcification could be identified during cine recording moving within the pulmonary outflow tract, a finding not commonly associated with this condition. The radiological investigation of IVLM is briefly discussed.

Female↗
PubMed1995

A histological basis for the 'sonographic snowstorm' in opportunistic infection of the liver and spleen.

We report 3 cases of opportunistic infection of the liver and spleen due to Pneumocystis carinii, Candida albicans and Aspergillus with an unusual but similar sonographic appearance. In the patient with Pneumocystis we report for the first time this same appearance in the bowel and pleura. Histology showed either extensive fibrosis or focal fibrinous exudates as the underlying cause. Calcification, though present, was scanty and was not thought to be the likely explanation for the appearances.

Adult↗
PubMed1995

Quantification of inflammatory bowel disease activity using technetium-99m HMPAO labelled leucocyte single photon emission computerised tomography (SPECT).

Technetium-99m HMPAO labelled white cell bowel uptake was quantified in 23 patients with suspected colitis by means of the novel technique of single photon emission computerised tomography (SPECT) using a standard gamma-camera. Uptake in colon segments was quantified on transaxial images and expressed as a fraction of marrow uptake (SPECT score). Segmental histological disease activity was assessed at colonoscopy (20) or at surgery (3). Segmental histology score correlated with SPECT score r = 0.79 (p < 0.001). Overall SPECT score for all affected segments correlated with Crohn's disease activity index (CDAI) r = 0.66, p = 0.001 and with laboratory activity indices; erythrocyte sedimentation rate r = 0.44, p = 0.03, C reactive protein r = 0.38, p = 0.05, and albumin r = -0.46, p = 0.03. Small bowel SPECT score in 13 patients correlated with CDAI r = 0.65, p < 0.01 but not with erythrocyte sedimentation rate or C reactive protein. Five patients with positive small bowel white cell uptake had normal C reactive protein and erythrocyte sedimentation rate. Overall SPECT score for disease at all sites correlated with both CDAI and with laboratory indices of inflammation. 99mTc HMPAO SPECT provides non-invasive and accurate quantification of inflammatory bowel disease activity in both large and small bowel and may be useful in the objective evaluation of treatment for inflammatory bowel disease.

Adult↗
PubMed1995

Comparison of 99m technetium hexamethylpropylene-amine oxime labelled leucocyte with 111-indium tropolonate labelled granulocyte scanning and ultrasound in the diagnosis of intra-abdominal abscess.

Fifty patients with suspected intra-abdominal abscess were investigated prospectively with ultrasound and with 99mTc-hexamethylpropylene-amine oxime (HMPAO) isotope labelled mixed leucocytes, using 111-In tropolonate granulocyte scanning as the reference standard. Twenty five patients had inflammatory bowel disease (three were postoperative): 21 of these had Crohn's disease and four had ulcerative colitis. The remainder comprised nine with postoperative fever and 16 with fever and abdominal pain. An abscess was diagnosed when focal activity on serial 111-In tropolonate and 99m-Tc-HMPOA images at one, three, and 24 hours resulted in activity at least equal to liver activity at 24 hours. Thirteen abscesses were diagnosed using each type of white cell scanning, resulting in 100% sensitivity for 99m-Tc-HMPAO compared with 111-In tropolonate. Bowel inflammation was easily distinguished from abscess on serial images. Eight of these 13 abscesses were detected by ultrasound. Altogether 17 abscesses were found. Ultrasound detected 12, including four liver abscesses which were not purulent and had not been detected by white cell scanning. Ultrasound had a sensitivity of 71% (12 of 17) and a specificity of 87% (33 of 38) using all confirmed abscesses as the reference standard. White cell scanning showed a sensitivity of 76% (13 of 17: as a result of the four non-purulent liver abscesses) and a specificity of 100%. 99m-Tc-HMPAO scanning is as accurate as 111-In tropolonate scanning, and has several advantages including simplicity, availability, superior image quality, and reduced radiation dose. Both methods are more sensitive and specific than ultrasound for intra-abdominal abscess detection but ultrasound is advisable if a neutrophil infiltrate is not suspected.

Abdominal Abscess↗
PubMed1995

Is day case liver biopsy underutilised?

Day case liver biopsies are rarely performed nationally but have been routine practice in selected patients in our hospital since 1989. We have audited our experience of this procedure to compare its safety, and efficacy with inpatient biopsy and assess patient acceptability. Audit data were collected retrospectively on liver biopsies performed at a teaching hospital over 42 months. Acceptability of day case biopsy was assessed by a questionnaire. A total of 182 of 546 biopsies were day cases (33%). The specimen quality was similar in both groups. The overall complication rate did not significantly differ between the two groups (2.7% day case v 3.3% inpatients). There were no deaths or episodes of haemorrhage in the day cases but one patient developed a pneumothorax. Some 91% of those who had a day case biopsy were satisfied with the procedure. Day case liver biopsy is safe, effective, and acceptable in selected patients.

Adult↗
PubMed1995

Upper limb lymphatic function in inflammatory arthritis.

OBJECTIVE: To determine the effect of inflammatory arthritis on lymphatic function in the upper limb. METHODS: Lymphoscintigraphy was used to measure lymphatic drainage in the upper limbs of 3 groups of patients: Group 1, inflammatory arthritis and edema (N = 10); Group 2, inflammatory arthritis and no edema (N = 18); and Group 3, healthy controls (N = 11). RESULTS: Lymphatic drainage was reduced significantly in Group 1 but was the same in Groups 2 and 3. Multiple regression analysis failed to show any effect of arthritis on lymphatic drainage. CONCLUSION: Inflammatory arthritis alone does not impair lymphatic drainage in the upper limbs. The results suggest that the presence of edema is primarily attributable to an unrelated abnormality influencing lymphatic function.

Adult↗
PubMed1994

Ultrasound findings in renal parenchymal disease: comparison with histological appearances.

Ultrasound examination was carried out in 55 patients undergoing renal biopsy for suspected renal parenchymal disease. Analysis of sonographic and histological findings showed statistically significant positive correlations between renal size and the extent of glomerular hyper-cellularity and crescent formation and between cortical echogenicity and severity of glomerular sclerosis, crescent formation, interstitial inflammatory cell infiltration, tubular atrophy and interstitial fibrosis. Positive correlation was also observed between prominence of the medullary pyramids and glomerular sclerosis. The most marked sonographic abnormalities were seen in proliferative (including crescentic) glomerulonephritis, diabetic glomerulosclerosis and tubulo-interstitial nephritis. IgA, membranous and minimal change nephropathy were less likely to be associated with sonographic abnormalities. We conclude that certain sonographic appearances in renal parenchymal disease reflect the presence and severity of light microscopical abnormalities but, although ultrasound assessment provides a high positive predictive value for renal parenchymal disease, specific conditions cannot be distinguished.

Adult↗
PubMed1994

Intraluminal bile duct hepatocellular carcinoma.

Jaundice is usually a late feature in the course of hepatocellular carcinoma and is only rarely due to obstruction. We present two cases of obstructive jaundice, in which the cause of obstruction in both patients was a massive intraluminal filling defect within the common bile duct which proved to be hepatocellular carcinoma. The radiological features are described.

Aged↗
PubMed1994

Kinetics of hepatic bile acid handling in cholestatic liver disease: effect of ursodeoxycholic acid.

BACKGROUND/AIMS: Ursodeoxycholic acid (UDCA) is clinically beneficial in chronic cholestatic liver disease, but the underlying mechanisms are unclear. It has been suggested that intrahepatic retention of endogenous hydrophobic bile acids contributes to cholestasis and that the hydrophilic bile acid UDCA reduces this retention; the aim of our study was to test these hypotheses. METHODS: Twelve patients with primary biliary cirrhosis (PBC) and 5 with primary sclerosing cholangitis (PSC) were studied before and during UDCA (10 mg.kg-1.day-1) and compared with 11 healthy controls. Following intravenous 75Se labeled homocholic acid taurine (75SeHCAT) in the fasting state, abdominal gamma camera imaging was performed for 90 minutes. Initial hepatic uptake, transit time, net, and absolute excretory rates for 75SeHCAT were measured. RESULTS: Mean initial hepatic uptake was not different between patients and controls (17.2% and 19.9% dose/minute, not significant). However, net and absolute excretory rates were significantly reduced in patients (1.4% vs. 3.7% dose/minute, P < 0.0001; and 2.35% vs. 3.96% dose/minute, P < 0.02, respectively), and hepatic transit time was prolonged (18.7 minutes vs. 11.6 minutes, P < 0.002). UDCA improved net and absolute hepatic excretory rates and transit time (1.43% to 1.96% dose/minute, P < 0.001; 2.35% to 3.15% dose/minute, P < 0.005 and 18.7 to 14.7 minutes, P < 0.001, respectively). However, UDCA did not alter initial hepatic uptake. CONCLUSIONS: In PBC and PSC, there is a defect in hepatic bile acid excretion but not in uptake, implying bile acid retention. This retention is reduced by UDCA.

Adult↗
PubMed1994

Transcatheter embolization of large idiopathic renal arteriovenous fistula.

Renal arteriovenous fistulas are unusual lesions with a variety of clinical manifestations. Congenital and acquired forms have been treated successfully with transcatheter embolization for 2 decades. In the case of large aneurysmal lesions the risk of inadvertent pulmonary embolism has traditionally precluded this approach and necessitated open surgery. However, with refinements in angiographic equipment and technique, such an approach is now feasible and desirable.

Adult↗
PubMed1994

Splenic sepsis in sickle cell disease.

We describe two patients with sickle cell disease (SCD) who developed infections situated in the spleen. One patient had a splenic abscess and there was strong clinical evidence for an infected splenic infarct in the second patient. SCD predisposes to splenic infection because of functional hyposplenism, defective phagocyte function and splenic infarction. Splenic infections can occur in patients who might be considered to have an absent spleen and the diagnosis of splenic abscess should be considered in individuals with SCD who present with fever and abdominal pain.

Abscess↗
PubMed1994

The role of ultrasound scanning.

Abdominal abscess, if left untreated, has a high mortality rate. Inadequate means of diagnosis and localization was responsible for this high mortality. Ultrasound now provides a simple non-invasive procedure permitting diagnosis with a high degree of sensitivity, although specificity is less commonly achieved. Abscesses do not have absolutely specific features, but given the appropriate clinical context and fine needle aspiration a diagnosis can be made in virtually 100% of cases, i.e. if the lesions can be identified and not obscured by bowel gas and examinations are not rendered difficult by surgical wounds and dressings. Diagnostic aspiration and therapeutic drainage are readily carried out using ultrasound guidance. Ultrasound is also of value in following the progress of lesions.

Abdominal Abscess↗
PubMed1994

Ultrasound scanning.

Inflammatory or neoplastic bowel pathology is associated with thickening of the bowel wall. Ultrasound appearances reflect the pathological changes in the bowel. Crohn's disease is a transluminal disease leading to fibrosis. This fibrosis is responsible for the formation of an echo-poor halo surrounding a central echogenic zone. In the earlier stages with transmural oedema and inflammation, the halo assumes a ground glass appearance. Ulcerative colitis is a mucosal disease and hence the halo is a less prominent feature. Severe oedema in the bowel wall in fulminant ulcerative colitis can be recognized by the marked reduction of the haustral and central lumen of the colon.

Colitis, Ulcerative↗
PubMed1994

Upper limb lymphedema associated with polyarthritis of rheumatoid type.

OBJECTIVE: To determine the cause of upper limb edema in 8 patients with peripheral polyarthritis of rheumatoid-type. METHODS: Objective assessment of lymph function using quantitative lymphoscintigraphy. RESULTS: Seven cases with either rheumatoid or psoriatic arthritis were found to have impaired lymph drainage associated with edema. All cases shared a distal rheumatoid pattern of arthritis but showed no relation between severity of lymphatic impairment and either duration or severity of arthritis. CONCLUSION: Polyarthritis of rheumatoid-type may be associated with lymphedema due to impaired lymphatic function.

Adult↗
PubMed1993

Space in its place: developing the link in medical geography.

This paper argues that a re-examination of the interrelationship between constructs of place and space is crucial to geography's involvement in the broader endeavour of health research. Place has re-emerged as nexus of ascribed meaning within contemporary social theory. Places, however, are related in space, by distance or proximity. The distinction needs to be made between this orthodox (geometric) view of space and two types of social space: the (experienced) space described by humanist geographers; and the more recent (socio-spatial) conceptualization which is both experienced and (re)produced by societal structures and advocated by social theorists in geography. We argue that advancing a recursive understanding of space and place is an appropriate direction in medical geography. This direction will include both an understanding of the ways in which space shapes the character of places and how the particularities of places resist or set in motion (orthodox) spatial processes. Illustrations are drawn from studies of mental illness and mental health care and primary health care in a remote area of New Zealand.

Cross-Cultural Comparison↗