Biomedical subjects

B Romanowski

Publications and source records attributed to B Romanowski.

At least 19 recordsLinked to original sources

PubMed2004

Interferon treatment of multiple pulmonary malignancies associated with papilloma virus.

Over a period of four years, beginning in spring 1988, a previously healthy man developed a primary squamous cell carcinoma of the tonsil, treated with radiotherapy, followed by 10 distinct, primary bronchial squamous cell carcinomas. Four of the cancers were surgically resected, all of which were positive by hybridization for human papilloma virus (type 16). Following the institution of alpha interferon, three smaller lesions disappeared and a larger one shrank in size, facilitating surgical resection. Over the following seven years no new ones have appeared. The finding of papilloma virus in malignancies should prompt consideration of antiviral therapy.

Adult↗

PubMed2001

Endocervical Gram stain smears and their usefulness in the diagnosis of Chlamydia trachomatis.

OBJECTIVE: To evaluate the usefulness of endocervical Gram stain smears in the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in a female population attending a STD clinic. METHODS: 494 females attending a STD clinic and undergoing a speculum examination had endocervical specimens submitted for C trachomatis culture, direct fluorescent antibody testing (DFA), and N gonorrhoeae culture. Endocervical smears were also collected for Gram stain. The number of polymorphonuclear leucocytes (PMN) per high power field (HPF), presence of bacteria, yeast, red blood cells, and clue cells were recorded. Clinical signs of cervicitis were also documented. RESULTS: N gonorrhoeae was isolated from one subject who was co-infected with C trachomatis and no further analysis was done regarding N gonorrhoeae. Analysis was performed on 220 participants. The prevalence of C trachomatis infection was 13%. Of the Gram smears collected, 55% were inadequate owing to the presence of vaginal contamination. There were an equal number of C trachomatis isolates in patients with < or = 10 PMN/HPF (48%) and > 10 PMN/HPF (52%). Endocervical mucopus and erythema were statistically significant for the presence of C trachomatis (p < 0.001 and 0.02 respectively). The presence of any signs of cervicitis-that is, mucopus, friability, erythema, and ectropion together with > 10 PMN/HPF was statistically significant for the presence of C trachomatis. CONCLUSION: The use of endocervical Gram smear results together with clinical information can be used to identify high risk women for C trachomatis infection.

Adolescent↗

PubMed2000

Efficacy and safety of famciclovir for treating mucocutaneous herpes simplex infection in HIV-infected individuals. Collaborative Famciclovir HIV Study Group.

OBJECTIVE: To compare the efficacy and safety of 7 days' treatment with famciclovir 500 mg twice a day versus acyclovir 400 mg five times a day, for mucocutaneous herpes simplex virus (HSV) infection in HIV-infected individuals. DESIGN: Randomized, double-blind, parallel-group study to demonstrate equivalence for the primary efficacy parameter. SETTING: Forty-eight hospital-based or specialist public-health clinics in 12 countries. PATIENTS: Two-hundred and ninety-three HIV-positive patients with recurrent HSV infection (orolabial or genital) starting treatment within 48 h of first appearance of herpetic lesions. MAIN OUTCOME MEASURES: Proportion of patients developing new lesions during treatment (primary outcome measures); Time to complete healing of lesions, time to cessation of viral shedding, time to loss of lesion-associated symptoms, number of withdrawals due to treatment failure (secondary outcome measures). RESULTS: Equivalence was defined prospectively and famciclovir was equivalent to acyclovir in preventing new lesion formation: new lesions occurred in 16.7% and 13.3% of patients, respectively [difference, 3.4%; 95% confidence interval (CI), -4.8-11.5]. The groups were comparable in time to complete healing (median 7 days for both groups; hazard ratio, 1.01; 95% CI, 0.79-1.29; P = 0.95), cessation of viral shedding (median of 2 days [hazard ratio = 0.93; 95% C.I. 0.68, 1.27; p = 0.64]), and loss of lesion-associated symptoms (median 4 days; hazard ratio, 0.99; 95% CI, 0.75-1.30; P = 0.93). Similar numbers in each group withdrew because of treatment failure. There were no differences between groups in the incidence of adverse events. CONCLUSIONS: Famciclovir given twice a day is as effective and well tolerated as high-dose acyclovir for mucocutaneous HSV infections in HIV-infected individuals, and has the convenience of less frequent dosing.

2-Aminopurine↗

PubMed2000

Near-real-time guidance using intraoperative magnetic resonance imaging for radical evacuation of hypertensive hematomas in the basal ganglia.

OBJECTIVE: To report our preliminary clinical experience in treating patients with hypertensive hemorrhage in the basal ganglia using a minimally invasive approach facilitated by intraoperative real-time imaging of an open magnetic resonance imaging (MRI) system and a newly designed cutting suction device. METHODS: We developed an artifact-free device for use during intraoperative MRI consisting of a guiding base that locks into a burr hole, a side-cutting composite-based cannula connected to a standard aspirator, and a handpiece that allows aspiration strength to be regulated by the surgeon. Thirteen patients with hypertensive bleeding in the basal ganglia were included in the study. Outcome was evaluated by mortality, Glasgow Outcome Scale score, activities of daily living score, and Rankin score at 2 weeks and at a median of 4.2 months after the hemorrhage. RESULTS: In this group of 13 patients, complete evacuation was achieved in 8 patients (62%) and subtotal evacuation of 75 to 90% of the initial volume in 4 patients (31%); the evacuation was partial in 1 patient (8%). Vascular malformations were preoperatively excluded angiographically. There was no rebleeding during surgery or postoperatively, as demonstrated by immediate postoperative MRI and computed tomography on the 1st postoperative day. Hematomas were evacuated on median Day 4 after the hemorrhage, varying between Day 1 and Day 8; evacuation was performed on Day 21 after the hemorrhage in one patient. Twelve of the 13 patients survived during a median follow-up time of 4.2 months. Neurological function improved in 11 of the 12 patients eligible for assessment. One patient with an additional head injury died 15 days after surgery from pulmonary embolism. CONCLUSION: This study shows an excellent outcome with regard to mortality and a positive trend regarding neurological outcome for the specific group of patients with hypertensive hematomas in the basal ganglia. This minimally invasive approach is feasible in the open intraoperative MRI in combination with the cutting suction device developed in our institution. Online imaging is extremely helpful for planning, guiding, and real-time monitoring of the procedure.

Adult↗

PubMed2000

Positional MR imaging of the lumbar spine: does it demonstrate nerve root compromise not visible at conventional MR imaging?

PURPOSE: To evaluate whether positional magnetic resonance (MR) images of the lumbar spine demonstrate nerve root compromise not visible on MR images obtained with the patient in a supine position (conventional MR images). MATERIALS AND METHODS: Thirty patients with chronic low back pain unresponsive to nonsurgical treatment and with disk abnormalities but without compression of neural structures were included. Positional MR images were obtained by using an open-configuration, 0.5-T MR imager with the patients seated and with flexion and extension of their backs. The disk and nerve root were related to the body position. Nerve root compression and foraminal size were correlated with the patient's symptoms, as assessed with a visual analogue scale. RESULTS: Nerve root contact without deviation was present in 34 of 152 instances in the supine position, in 62 instances in the seated flexion position, and in 45 instances in the seated extension position. As compared with the supine position, in the seated flexion position nerve root deviation decreased from 10 to eight instances; in the seated extension position, it increased from 10 to 13 instances. Nerve root compression was seen in one patient in the seated extension position. Positional pain score differences were significantly related to changes in foraminal size (P =.046) but not to differences in nerve root compromise. CONCLUSION: Positional MR imaging more frequently demonstrates minor neural compromise than does conventional MR imaging. Positional pain differences are related to position-dependent changes in foraminal size.

Adult↗

PubMed2000

A new artifact-free device for frameless, magnetic resonance imaging-guided stereotactic procedures.

OBJECTIVE: A new, artifact-free, nonobstructive device was required for planning, guiding, and performing stereotactic procedures in an open magnetic resonance imaging (MRI) system (Signa SP; General Electric, Milwaukee, WI). DESCRIPTION OF INSTRUMENTATION: We devised an MRI-compatible instrument set that was adapted to an optical triangulation system (FlashPoint System; Image Guided Technologies, Boulder, CO) and consisted of a Pathfinder for planning burr holes and trajectories and a Snapper-Stereoguide for guiding minimally invasive instruments such as biopsy cannulae, endoscopes, and laser fibers. The instruments were composed of biocompatible plastic (polyacetal). During evaluation, special attention was paid to safety, accuracy, operation times, and susceptibility artifacts of the system. RESULTS: The first 20 stereotactic procedures performed in the open MRI scanner included 15 biopsies, 1 cyst and 3 abscess evacuations, and 1 endoscopic procedure for treatment of multiseptate hydrocephalus. There were no adverse outcomes, and all biopsies were diagnostic. The frameless stereotactic system in combination with the FlashPoint System proved to be accurate, with a mean error of 1.5 mm. The biopsy devices did not cause any susceptibility artifacts. Highly vascularized structures were clearly visible and were included in the trajectory planning. With experience, the procedure time was reduced to less than 1 hour. CONCLUSION: This device was found to be quite helpful for planning and guiding stereotactic procedures in the open MRI scanner. Nearly real-time planning and monitoring of stereotactic procedures and the positional accuracy of the system make the open MRI system a definite improvement, compared with conventional stereotactic systems.

Adolescent↗

PubMed1999

Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features.

Syphilis is a chronic disease with a waxing and waning course, the manifestations of which have been described for centuries. It occurs worldwide, and the incidence varies significantly with geographic location. Transmission is mainly by sexual contact. The causative organism, Treponema pallidum, was first described in 1905, but because of the inability to culture the organism and the limitations of direct microscopy, serologic testing is the mainstay of laboratory diagnosis. The disease has been arbitrarily divided into several stages. The primary stage is defined by a chancre at the site of inoculation. The secondary stage is characterized by a polymorphic rash, lymphadenopathy, and other systemic manifestations. A variable asymptomatic latent period follows, which for epidemiologic purposes is divided into early (<1 year) and late (>1 year) stages. The early stages (primary, secondary, and early latent) are potentially infectious. The tertiary stage is the most destructive and is marked by cardiovascular and neurologic sequelae and gummatous involvement of any organ system. Congenital infection may result in protean early or late manifestations. Unlike many other bacteria causing infectious diseases, the organism remains sensitive to penicillin, and this remains the mainstay of therapy.

HIV Infections↗

PubMed1999

Changes in cross-sectional measurements of the spinal canal and intervertebral foramina as a function of body position: in vivo studies on an open-configuration MR system.

OBJECTIVE: The purpose of this study was to evaluate physiologic changes of the cross-sectional area of the spinal canal and neural foramina in young asymptomatic volunteers. SUBJECTS AND METHODS: Twelve asymptomatic volunteers were examined in a 0.5-T open-configuration MR system. T2-weighted fast spin-echo sequences were obtained in upright neutral, upright flexed, upright extended, and supine extended positions. The cross-sectional area of the spinal canal and the thickness of the ligamentum flavum were measured on angled axial images at the L4-L5 level. The anteroposterior diameter of the spinal canal and cross-sectional areas of the neural foramina were measured on sagittal images from L1 to S1. RESULTS: At disk level, the cross-sectional area of the spinal canal varied significantly between body positions, most notably between the upright flexed (mean, 268 mm2) and the upright extended (mean, 224 mm2) positions (p < .0001). The maximum thickness of the ligamenta flava increased in the extended positions (p < .0001). The cross-sectional area of the neural foramina underwent position-dependent variations of as much as 44.4%. The smallest cross-sectional areas were found in the extended positions. CONCLUSION: In asymptomatic volunteers, MR imaging is able to show position-dependent changes in the cross-sectional areas of the spinal canal and the intervertebral foramina. The extended positions best reveal important findings.

Adult↗

PubMed1998

Interactive MR-guided biopsies of the thyroid gland: validation of a new method.

The aim of this study was to demonstrate the clinical feasibility and utility of an interactive MR-guidance system to target and biopsy thyroid lesions, and to compare resolution between ultrasound and interventional MR imaging in the evaluation of thyroid lesions. Twenty thyroid lesions of 18 patients were interactively biopsied using a 0.5-T superconducting open magnet system. Stereotactic localization of the needle and imaging was accomplished using T1-weighted gradient-recalled-echo (GRE) images. Representative cytological material was retrieved in 16 of 20 lesions (benign cystic or colloid goiter: n = 14; one de Quervain's thyroiditis and one follicular neoplasia). Lesions smaller than 1.5 cm detected by ultrasound could not be visualized adequately on GRE images. Lesions smaller than 1.5 cm were successfully biopsied by ultrasound (three colloid and haemorrhagic goiters and one adenoma). Magnetic-resonance-guided interactive biopsies and positioning of non-ferromagnetic needles in the thyroid gland are technically feasible and safe. Compared with high-resolution ultrasound, lesions larger than 1.5 cm can be adequately visualized and biopsied. Magnetic-resonance-guided placement of non-ferromagnetic needles is no substitute for high-resolution ultrasound in clinical work-up of thyroid lesions.

Biopsy, Needle↗

PubMed1998

Randomised double blind trial of EMLA for the control of pain related to cryotherapy in the treatment of genital HPV lesions.

OBJECTIVE: To evaluate the efficacy of EMLA (eutectic mixture of local anaesthetic) for the control of pain related to cryotherapy for the treatment of human papilloma virus (HPV) in the outpatient setting. DESIGN: A randomised, double blind, placebo controlled study. SUBJECTS: 40 patients (20 male and 20 female) with external genital HPV involving an area of no greater than 1 cm2. SETTING: The Capital Health Sexually Transmitted Disease Clinic, Edmonton, Alberta, Canada. RESULTS: Patients in whom EMLA was utilised reported significantly lower scores than those in the control group. Women reported pain scores of 4.7/10 and 0.9/10 in placebo and EMLA groups respectively (p < 0.01). Men reported pain scores of 6.4/10 and 3.1/10 in placebo and EMLA groups respectively (p < 0.01). Men reported significantly higher pain scores than women in the EMLA groups (p < 0.01). There was no significant difference in pain scores between men and women in the placebo groups. CONCLUSION: EMLA can provide efficacious topical anaesthesia before cryotherapy for the treatment of external genital HPV.

Adolescent↗

PubMed1998

Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography.

PURPOSE: To compare measurements of the sagittal diameter of the lumbar dural sac obtained at positional magnetic resonance (MR) imaging and at functional myelography and to assess the influence of various body positions on the dural sac and the intervertebral foramina. MATERIALS AND METHODS: Thirty consecutive patients referred for lumbar myelography were examined with an open 0.5-T MR imager, Sagittal T2-weighted fast spin-echo images were acquired with patients in the supine, upright flexion, and upright extension positions. The midsagittal diameter of the dural sac was measured at the level of the disks on MR images and myelograms. Foraminal sizes on the MR images were scored independently by two observers. RESULTS: Correlation between MR imaging and myelographic measurements was high (r = .81-.97). A small but statistically significant positional dependence of the dural sac diameter was found in the lower lumbar spine. Position-dependent differences in foraminal scores were uncommon. CONCLUSION: Quantitative assessment of sagittal dural sac diameters is comparable between lumbar myelography and positional MR imaging. In a selected patient population, only small changes in the sagittal diameter of the dural sac and foraminal size can be expected between various body positions, and the information gained in addition to that from standard MR imaging is limited [corrected].

Adult↗

PubMed1997

First year serologic response to treatment for syphilis: a model for prediction of seroreversion.

There is no straightforward test available, within weeks of treatment for syphilis, to assess adequacy of serologic response. We propose a method to predict non-treponemal seroreversion based on short term response. To develop and illustrate this method, we used data from 370 individuals with infectious syphilis. Individual serologic response appears to be a linear function of (log) time, suggesting the possibility of using rapid plasma reagin titres recorded in the first few months after treatment to determine the slope of the linear treatment response line. The slope of the response line, during the first year after treatment, is an important predictor of seroreversion but must be considered in conjunction with pre-treatment titre. We recommend development of an action line be developed based on these variables. Such a line would indicate the necessity for retreatment if the line plotted from the patient's first year response failed to fall below the action line.

Adult↗

PubMed1997

Human immunodeficiency virus seroprevalence and risk behaviors in patients attending sexually transmitted disease clinics in Alberta.

OBJECTIVE: To investigate the dissemination of human immunodeficiency virus (HIV) and hepatitis C infection in association with sexually transmitted diseases (STDs), sexual practices, and injection drug use. All eligible men and women attending two STD clinics in Alberta, Canada, from May 1994 to May 1995 were studied. STUDY DESIGN: Anonymous, unlinked serosurveys were performed using leftover sera drawn for routine syphilis, hepatitis B, or HIV testing. Self-administered questionnaires collected a wide range of data: demographic, sexual behaviors, condom use, STD history, the exchange of drugs or money for sex, and drug and alcohol use. RESULTS: HIV seroprevalence in the overall sample group (n = 6,668) was 1.5%. Univariate analysis showed significant relationships for age between 30 years and 49 years, men having sex with men, injection drug use regardless of sexual orientation, history of STD, anal sex, and exchanging money or drugs for sex. At the multivariate level, only men having sex with men, injection drug use, and age more than 30 years remained predictive of HIV infection. The prevalence of hepatitis C was 3.4% with significant associations being injection drug use and exchanging money or drugs for sex. CONCLUSION: The behavioral associations between sex practices, injection drug use, and HIV and hepatitis C seroprevalence warrant ongoing investigation. Continuing prevention programs targeted at safer sex practices (particularly for men having sex with men) and the use of clean needles are needed.

Adolescent↗

PubMed1997

Laser ablation-induced changes in the prostate: findings at endorectal MR imaging with histologic correlation.

PURPOSE: To correlate laser ablation-induced changes in the prostate as depicted at endorectal magnetic resonance (MR) imaging with results at histologic examination. MATERIALS AND METHODS: In eight patients with prostate carcinoma, visually guided laser ablation was performed during lymphadenectomy. Radical prostate resection was performed 4-9 days (mean, 6.9 days) after ablation in seven patients and at 70 days in one patient. The study protocol consisted of (a) endorectal T2-weighted fast spin-echo imaging, (b) dynamic T1-weighted spoiled gradient-echo imaging prior to and after injection of contrast material, and (c) gadolinium-enhanced T1-weighted spin-echo imaging. Imaging findings were correlated with macroscopic and histologic findings. RESULTS: Histologic examination revealed periurethral necrosis with a marginal zone that consisted of partially necrotic tissue, dilated vessels, and hemorrhagic areas. Considerable interindividual difference was observed in the extent of morphologic alterations (area, 0-18.0 cm3). Gadolinium-enhanced images were best suited for assessment of laser ablation-induced changes. The correlation between the volume of altered tissue measured on MR images and in macroscopic specimens was excellent (r2 = .96). CONCLUSION: MR imaging helped monitor changes induced with laser ablation (which differed greatly among individuals). MR monitoring may thus be useful in patients with obstructive benign prostatic hyperplasia after laser ablation.

Aged↗

PubMed1996

Azygos blood flow: phase contrast quantitation in volunteers and patients with portal hypertension pre- and postintrahepatic shunt placement.

Flow volume in the azygos venous system was quantitated with Cine-phase contrast (PC) velocity mapping in volunteers and compared with patients with known portal hypertension, who were referred for transjugular intrahepatic portosystemic shunt (TIPS) placement. Subsequently, the TIPS-induced hemodynamic effects on portal and azygos flow were analyzed. To assess intra- and intersubject variability, flow in the azygos veins was measured in each of 10 normal subjects at three different times. Subsequently, portal and azygos flow was quantitated in 20 patients with portal hypertension, before and after TIPS placement. All imaging was performed on a 1.5-tesla magnetic resonance imaging (MRI) system. Azygos flow was measured transaxially at the midthoracic level. Cine-PC flow measurements of the main portal vein followed morphological evaluation of the portal venous system with axial and coronal breath-held magnet resonance angiogram. Azygos flow in normal subjects was characterized by high inter- and low intrasubject variability. Azygos flow in patients with portal hypertension was significantly higher (P < .001). Following successful TIPS placement in 18 patients, Cine-PC revealed a mean decrease in azygos flow of 46.3% (P < .001) and a 134% (P < .001) increase of portal flow. Reflecting the complexity of portal hemodynamics, there was no correlation between the changes in the portal and azygos systems. In 2 patients with early occlusion of TIPS, documented invasively, portal and azygos flow values remained largely unchanged. Cine-PC enables the noninvasive, quantitative assessment of flow within the azygos venous system. Azygos flow was found to be markedly elevated in patients with portal hypertension. Combined portal and azygos PC flow measurements quantitate the therapeutic effect of TIPS placement.

Adult↗

PubMed1994

Factors affecting urine EIA sensitivity in the detection of Chlamydia trachomatis in men.

OBJECTIVE: This study examined the effects of four variables on the detection of Chlamydia trachomatis in urine from men by enzyme immunoassay (EIA). These variables were: symptoms and signs of urethritis, urine polymorphonuclear leucocytes (PMN), inclusion counts from urethral chlamydia cell cultures and the time between testing and last voiding. METHODS: Included were patients with and without symptoms and/or signs of urethritis attending the Edmonton Sexually Transmitted Disease Clinic. Men were asked to submit a 20 ml volume urine sample. Urethral swabs were collected for gram stain, chlamydia and gonorrhea culture. RESULTS: A total of 318 men were evaluated of whom 47 had chlamydia. Excluding six men who were coinfected with gonorrhoea, sensitivities and specificities of the Microtrak, Chlamydiazyme and IDEIA systems were 78.1% and 99.6%, 75.6% and 100%, and 80.5% and 97.8% respectively. Last void time did not affect the sensitivity. However, sensitivity was best when applied to men with severe evidence of urethritis. CONCLUSION: There is evidence that urine EIA could be used to detect chlamydia in men with acute urethritis but not in those without signs of urethritis.

Chlamydia Infections↗

PubMed1993

Minocycline compared with doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis.

OBJECTIVE: To compare the efficacy and tolerability of minocycline versus doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis. DESIGN: Randomized, double-blind trial. SETTING: Sexually transmitted disease clinics. PATIENTS: 151 men and 102 women with nongonococcal urethritis, mucopurulent cervicitis or whose sexual partner had either condition or a positive culture for Chlamydia trachomatis. INTERVENTIONS: Minocycline, 100 mg nightly, or doxycycline, 100 mg twice daily, each administered for 7 days. MEASUREMENTS: At each visit (days 14 +/- 3, 28 +/- 5, and 49 +/- 7) patients were questioned regarding symptoms, signs, drug compliance, and sexual contact. Cultures for C. trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis were obtained at each visit. RESULTS: 253 patients were enrolled (133, doxycycline; 120, minocycline). Chlamydia trachomatis was initially isolated from 31% of men and 39% of women. Men with a positive smear had a higher symptom/sign score (P < 0.001) and were more likely to have chlamydia (P = 0.004). Positive endocervical smears were not associated with symptoms or signs (P > 0.2) but correlated with isolation of chlamydia (P < 0.001). One hundred sixty-two patients (64%) completed the study. The proportion with urethritis or cervicitis did not differ by treatment group at any follow-up visit (P > 0.08). Unprotected sexual contact did not affect clinical or microbiological cure rates. Adverse effects occurred more frequently in the doxycycline group (men: 43% versus 26%; P = 0.05; women: 62% versus 35%; P = 0.009). Although the proportion with dizziness did not differ by drug administered (P = 0.1), dizziness was reported more often by women (11% versus 3%). CONCLUSIONS: Minocycline, 100 mg nightly, was as effective as doxycycline, 100 mg twice daily, each given for 7 days in the treatment of nongonococcal urethritis and mucopurulent cervicitis. Vomiting and gastrointestinal upset occurred more frequently in the doxycycline group.

Adolescent↗

PubMed1993

Pelvic inflammatory disease. Current approaches.

Pelvic inflammatory disease is an important cause of acute and chronic morbidity among women of reproductive age, and PID rates are rising. Clinical diagnosis of PID is often inaccurate, but can be improved by knowledge of risk factors and use of simple investigations. Early diagnosis and the institution of appropriate treatment regimens, including evaluation and prompt treatment of sexual partners, are essential to prevent PID's devastating sequelae.

Adolescent↗