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Biomedical subjects

A L Cox

Publications and source records attributed to A L Cox.

35 records · Page 2Linked to original sources
PubMed1993

Surgical treatment of Pancoast tumor.

The treatment of superior pulmonary sulcus (Pancoast) tumor is not uniform and is still discussed. Literature data and our retrospective study are presented. Fourteen patients were operated for a Pancoast tumor. Nine patients underwent mediastinoscopy followed by preoperative radiotherapy. Five patients received adjuvant radiotherapy after incomplete resection. Five patients who did not have preoperative radiotherapy, received postoperative irradiation. All three patients who survived five years or more, had preoperative radiotherapy and two of them underwent a complete resection. Literature data are discussed and emphasis is laid on the importance of preoperative staging, including mediastinoscopy, preoperative radiotherapy and complete "en bloc" resection.

Adult↗
PubMed1992

Peptides presented to the immune system by the murine class II major histocompatibility complex molecule I-Ad.

Between 650 and 2000 different peptides are associated with the major histocompatibility complex class II molecule I-Ad. Sequences for nine of these were obtained by a combination of automated Edman degradation and tandem mass spectrometry. All of the peptides are derived from secretory or integral membrane proteins that are synthesized by the antigen-presenting cell itself. Peptides were 16 to 18 residues long, had ragged NH2-and COOH-termini, and contained a six-residue binding motif that was variably placed within the peptide chain. Binding data on truncated peptides suggest that the peptide binding groove on class II molecules can be open at both ends.

Amino Acid Sequence↗
PubMed1992

[Generalized sarcoidosis in combination with a malignancy in 3 patients; the value of mediastinoscopy].

Two male patients with a testicular carcinoma and a female with a mammary carcinoma, all associated with pulmonary sarcoidosis are described. This coincidence is very rare, but clinically relevant as enlarged mediastinal and hilar lymph nodes might suggest metastatic disease or metastasis after a curative treatment. The role of mediastinoscopy in obtaining a histological diagnosis is stressed. A causal relationship between sarcoidosis and malignant diseases has not yet been established.

Adult↗
PubMed1992

Characterization of peptides bound to the class I MHC molecule HLA-A2.1 by mass spectrometry.

Antigens recognized by T cells are expressed as peptides bound to major histocompatibility complex (MHC) molecules. Microcapillary high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry was used to fractionate and sequence subpicomolar amounts of peptides isolated from the MHC molecule HLA-A2.1. Of 200 different species quantitated, eight were sequenced and four were found in cellular proteins. All were nine residues long and shared a distinct structural motif. The sensitivity and speed of this approach should enhance the analysis of peptides from small quantities of virally infected and transformed cells as well as those associated with autoimmune disease states.

Amino Acid Sequence↗
PubMed1992

Pectus excavatum. A clinical study with long-term postoperative follow-up.

Between 1972 and 1987, 192 patients have been operated upon for pectus excavatum of which 152 patients were included in the study (79%). Mean age at operation was 15.3 +/- 5.5 years; 117 were male. Mean follow-up was 8.1 +/- 3.6 years. The deformity was noted before the age of 5 in 90%. Type I symmetrical and localized deformity was seen in 33.2%, type II symmetrical but diffuse depression in 23.7% and type III localized or diffuse asymmetrical deformity in 43.1%. It was considered severe in 68.9%, fair in 16.9% and mild in 14.2%. There were significantly more asymmetrical defects in the older age groups. The operation consisted of subperichondral chondrectomy, transverse sternotomy and division of the intercostal bundles at the outer limit of the chondrectomy and suturing the edge of this broad sheet of muscle and perichondrium to the anterior surface of the chest wall more laterally and under tension, elevating and stabilizing the sternum. Results were satisfactory in 83.6% (excellent 44.1%, good 39.5%). Results were not significantly influenced by age, sex, severity, type, symmetry, the extent of cartilage resection or follow-up. Results were inversely influenced by the occurrence of wound problems. The optimal age for operation is considered to be between 5 and 10 years. Both physical as well as psychological cosmetic factors may serve as an indication for operation.

Adolescent↗
PubMed1992

Mushroom worker's lung. Detection of antibodies against Shii-take (Lentinus edodes) spore antigens in Shii-take workers.

Indoor cultivation of the edible mushroom Shii-take (Lentinus edodes) regularly leads to symptoms of mushroom worker's lung (MWL) in workers. An immunologic test is described allowing detection of IgG type antibodies against Shii-take spore antigens. It was found that MWL patients employed in Shii-take picking (n = 5) have significantly increased antibody titres against Shii-take spore antigens. Different control groups, viz, MWL patients employed in the cultivation of the white button mushroom Agaricus bisporus (n = 14) and of the oyster mushroom Pleurotus spp (n = 3), patients with Bechterew's syndrome (n = 7), sarcoidosis (n = 7), rheumatoid arthritis (n = 9), and healthy controls were found in the same range of low titres. The use of protective masks during picking reduced complaints of the workers (n = 14). However, their antibody titres increased with duration of employment despite the protection.

Agricultural Workers' Diseases↗
PubMed1991

[Mushroom growers' lung; clinical diagnosis and treatment].

The objective of this study was to give a description of the clinical picture, diagnosis and treatment in 19 patients with mushroom grower's lung. Of these patients, six worked at mushroom compost manufacturing, seven were traced by means of a nationwide enquiry among mushroom growers and six were referred by GPs. The following factors were measured after provocation at the worksite: pulmonary function, blood gas values, leukocyte count and body temperature. On the day of the provocation and on a control day chest X-rays were made. The most frequent complaints were dyspnoea and fever (in 15 and 13 patients, respectively). Serological tests in 16 of the 19 patients revealed antibodies against various fungi that occur in locations where mushroom compost is handled. Six to 12 hours after the provocation, all patients showed a rise of the mean body temperature from 37.1 to 38.4 degrees C; the mean leukocyte count rose from 7.7 to 17.0 X 10(9)/l. Lung function studies revealed restrictive disorders: the mean VC fell from 5.15 to 4.50 l, the TLC from 6.80 to 6.18 l. The differences, tested with Wilcoxon's two-sample test were significant (p less than 0.001). Roentgenological abnormalities were seen in two patients (reticular lung image). Treatment consisted of preventive measures, such as improved air conditioning at the worksite, wearing masks, wetting the compost to keep it from flying about, and supplying pretreated compost requiring no personal preparation.

Adult↗
PubMed1991

[Hemoptysis caused by a retained piece of chest drain].

We describe a patient with haemoptysis 13 and 22 years after thoracotomy for a leiomyoma of the oesophagus. Despite extensive evaluation we did not get a firm diagnosis. The findings at bronchoscopy and microscopy suggested the possibility of a bronchial adenoma. At exploratory thoracotomy we found an intrapulmonary torn-off tip of a pleural drain. In retrospect, this foreign body was recognizable on the lung tomogram, the computerized tomogram and the magnetic resonance image. We discuss the diagnostic approach of a patient with non-massive haemoptysis.

Adenoma↗
PubMed1990

[The surgical treatment of the Pancoast tumor].

A retrospective study was made of eight patients who underwent operation in the period 1974-1987 because of a Pancoast (pulmonary sulcus) tumour. Of the five patients still alive, three have had no local recurrences for 15, 4 and 2 years, respectively, after the operation. Data from this investigation and from the literature confirm that the absence of metastases in mediastinal lymph nodes, and use of preoperative irradiation may have a favourable effect on the prognosis. The best result is achieved with preoperative irradiation followed by 'en bloc' resection of the affected pulmonary lobe, the tumour-infiltrated chest wall and, if necessary, part of the sympathetic trunk and the plexus brachialis inferior. Emphasis is laid on the importance of early recognition of the tumour in case of aspecific shoulder and arm symptoms.

Adenocarcinoma↗
PubMed1990

Primary malignant fibrous histiocytoma of the mediastinum.

A malignant fibrous histiocytoma of the mediastinum was successfully treated by surgery and radiotherapy. Magnetic resonance imaging was able to show the site of invasion, the two different components of the tumour, and the blood supply.

Female↗
PubMed1989

Surgical treatment of multiple primary lung cancers.

Multiple primary lung cancers are now being recognized more frequently. Out of 1004 patients with a resected lung cancer, 32 (3.2%) presented a second primary and two of them a third primary lung cancer. A synchronous (S) primary was present in 7 and a metachronous (M) primary was present in 25. The histology was different in 1/7 with a S. and in 6/25 with a M. cancer. In all cases the cancer was located in another segment, lobe or lung. Out of the 7 with a S. cancer, 3 had a one stage and 4 a staged resection; out of the 25 with a M. cancer, 3 were treated by chemotherapy, 22 had a 2nd and 1 a 3rd operation to remove a new cancer. The mean time interval in M. cancer was 4 years, 8 months and was longer for adeno- (8 years) than for squamous cell carcinomas (4 years), longer for a contralateral cancer (6 years, 7 months) and longer for mild smokers (5 years, 1 month). The early mortality (10.3%) was 0/7 for S. and 3/22 for M. cancers. The three and five years actuarial survival of operated patients was 67% and 25% for S. and 43% and 31% for M. cancers. Survival is positively affected by a resection interval of more than 3 years and by 3 instead of 2 remaining lobes after the second resection. In conclusion a close follow-up of operated lung cancer patients is necessary and aggressive surgical approach is indicated for a new primary cancer.

Adenocarcinoma↗
PubMed1989

Penetration into lung tissue after intravenous administration of amoxycillin/clavulanate.

In order to investigate the penetration of amoxycillin and clavulanate into lung tissue, ten patients with a malignancy requiring a pulmonary resection, receiving 2000 mg amoxycillin and 200 mg clavulanate by intravenous injection, were studied. Samples of whole blood were taken before dosing and at the time of tissue removal. One to five grams of healthy lung tissue was taken from a segment or lobe other than that in which the tumour was located. All serum and tissue samples were analysed by a microbiological assay. The mean period to elapse before serum sample collection was 41.8 min at which time the mean concentrations were amoxycillin 71.3 and clavulanate 7.8 mg/l. The mean period to elapse before tissue collection was 54.3 min at which time the mean concentrations were amoxycillin 34.1 and clavulanate 2.3 mg/kg. These levels of amoxycillin and clavulanate are high enough to inhibit important pathogens in the lower respiratory tract.

Adult↗
PubMed1988

Benign clear cell tumour of the lung--intermediate filament typing as a tool in differential diagnosis.

A case of a benign clear cell ('sugar') tumour of the lung in a 61-year-old woman is presented. Characteristic routine histological features are provided and problems concerning differential diagnosis are discussed. Immunohistochemical stainings for the intracytoplasmatic intermediate filament proteins keratin and vimentin in our patient suggest a mesenchymal origin for this rare pulmonary neoplasm, and provide useful diagnostic aid in inconclusive cases.

Cytoskeleton↗
PubMedDate not supplied

Parallelization of general-linkage analysis problems.

We describe a parallel implementation of a genetic-linkage analysis program that achieves good speed improvement, even for analyses on a single pedigree and with a single starting recombination fraction vector. Our parallel implementation has been run on three different platforms: an Ethernet network of workstations, a higher-bandwidth asynchronous transfer mode (ATM) network of workstations, and a shared-memory multiprocessor. The same program, written in a shared-memory programming style, is used on all platforms. On the workstation networks, the hardware does not provide shared memory, so the program executes on a distributed shared memory system that implements shared memory in software. These three platforms represent different points on the price/performance scale. Ethernet networks are cheap and omnipresent, ATM networks are an emerging technology that offers higher bandwidth, and shared-memory multiprocessors offer the best performance because communication is implemented entirely by hardware. On 8 processors and for the longer runs, we achieve speedups between 3.5 and 5 on the Ethernet network and between 4.8 and 6 on the ATM network. On the shared-memory multiprocessor, we achieve speedups in the 5.5-6.5 range for all runs.

Algorithms↗
PubMedDate not supplied

Combined cervical and left parasternal mediastinoscopy for pre-operative staging of left upper lobe lung cancer.

Since exploratory thoracotomy, incomplete and palliative resection do not in effect prolong life expectancy, it is essential to determine the operability of a lung tumor as accurately as possible. Cervical mediastinoscopy has dropped the percentage of exploratory thoracotomy considerably. However, the lymph nodes in the periaortic region cannot be reached at cervical mediastinoscopy and these form an important lymph drainage pathway for the left upper lobe. The periaortic lymph nodes can be explored by left parasternal mediastinoscopy. In the present study we investigate the value of combined cervical and left parasternal mediastinoscopy in all patients with a clinically operable central lung cancer in the left upper lobe, and in patients with a peripheral cancer of the left upper lobe, when the tumor histology is unfavourable, or when there is suspicion of invasion of the surrounding organs. In the retrospective group, we found metastases at cervical mediastinoscopy in 12.9% of the patients with a tumor of the left upper lobe. In the prospective group, we found metastases at cervical mediastinoscopy, in 41.9% of the patients with a tumor of the left upper lobe. All the patients with a positive mediastinoscopy were excluded from operation. In those cases the lymph nodes were involved, or at multiple localizations, or at one localization extranodulary. The number of exploratory thoracotomies dropped in the prospective period and the resectability increased from 79.4% to 96.5% for the left upper lobe. These data point to the reliability of left parasternal mediastinoscopy combined with the cervical mediastinoscopy in the assessment of the operability of the left upper lobe lung cancer, in order to avoid unnecessary thoracotomies.

Humans↗