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Biomedical subjects

C Lee

Publications and source records attributed to C Lee.

At least 1,117 records · Page 62Linked to original sources
PubMedDate not supplied

High-dose gadoteridol in MR imaging of intracranial neoplasms.

Twelve patients with a high suspicion of brain metastases by previous clinical or radiologic examinations were studied in a phase III investigation with magnetic resonance (MR) imaging at 1.5 T after a bolus intravenous injection of 0.1 mmol/kg gadoteridol followed at 30 minutes by a second bolus injection of 0.2 mmol/kg gadoteridol. All lesions were best demonstrated (showed greatest enhancement) at the 0.3-mmol/kg (cumulative) dose, with image analysis confirming signal intensity enhancement in the majority of cases after the second gadoteridol injection. More lesions were detected with the 0.3-mmol/kg dose than with the 0.1-mmol/kg dose, and more lesions were detected with the 0.1-mmol/kg dose than on precontrast images. In this limited clinical trial, high-dose gadoteridol injection (0.3-mmol/kg cumulative dose) provided improved lesion detection on MR images specifically in intracranial metastatic disease.

Adult↗
PubMedDate not supplied

Contrast-enhanced MR angiography.

Magnetic resonance (MR) angiography, although still in its infancy, is recognized as a valuable diagnostic tool. Investigation of the utility of contrast media as applied to MR angiography is, to no surprise, preliminary. In restricted instances, with present techniques, contrast media-enhanced MR angiography can provide additional valuable diagnostic information. Inspection of two-dimensional images (as opposed to three-dimensional projections) and comparison of MR images before and after administration of contrast agent are particularly important. Improved visualization of intracranial aneurysms, arteriovenous malformations, venous anomalies, and arterial occlusions has been demonstrated on three-dimensional time-of-flight MR angiograms after intravenous administration of a gadolinium chelate, relative to studies performed before administration of the contrast agent.

Animals↗
PubMedDate not supplied

PD 142676 (CI 1002), a novel anticholinesterase and muscarinic antagonist.

Inhibition of brain acetylcholinesterase (AChE) can provide relief from the cognitive loss associated with Alzheimer's disease (AD). However, unwanted peripheral side effects often limit the usefulness of the available anticholinesterases. Recently, we identified a dihydroquinazoline compound, PD 142676 (CI 1002) that is a potent anticholinesterase and a functional muscarinic antagonist at higher concentrations. Peripherally, PD 142676, unlike other anticholinesterases, inhibits gastrointestinal motility in rats, an effect consistent with its muscarinic antagonist properties. Centrally, the compound acts as a cholinomimetic. In rats, PD 142676 decreases core body temperature. It also increases neocortical arousal, as measured by quantitative electroencephalography, and cortical acetylcholine levels, measured by in vivo microdialysis. The compound improves the performance of C57/B10j mice in a water maze task and of aged rhesus monkeys in a delayed match-to-sample task involving short-term memory. The combined effect of AChE inhibition and muscarinic antagonism distinguishes PD 142676 from other anticholinesterases, and may be useful in treating the cognitive dysfunction of AD and produce fewer peripheral side effects.

Animals↗
PubMedDate not supplied

Preoperative chemoradiation for patients with locally advanced adenocarcinoma of the pancreas.

BACKGROUND: Improved resectability is a major theoretical benefit of preoperative chemoradiation for pancreatic cancer. Since 1994, patients at Duke University Medical Center with locally advanced pancreatic cancer have been treated with multimodality preoperative therapy. The purpose of this study was to review our experience with preoperative therapy for locally advanced pancreatic cancer and determine if an aggressive neoadjuvant regimen would not only downstage these tumors pathologically but also improve the odds of complete surgical resection. METHODS: The charts of 25 patients treated with neoadjuvant chemoradiation at Duke University Medical Center with biopsy-proven, locally advanced adenocarcinoma of the pancreas were reviewed. Tumors were defined as locally advanced based on radiographic or intraoperative evidence of disease that abuts the superior mesenteric artery or vein (n = 22) or involves lymph nodes that are within the proposed radiation field (n = 3). All 25 patients received external beam radiotherapy (median dose 4500 cGy) in daily fractions of 180 cGy over 5 weeks. All patients concurrently received 5-fluorouracil (FU), and many also received mitomycin C or cisplatin, or both. Patients were given a 3- to 4-week break before a restaging computed tomographic (CT) scan was performed. Three patients were not restaged: one died from metastatic disease; one was reclassified as having a neuroendocrine tumor; and one was lost to follow-up. RESULTS: On restaging after neoadjuvant therapy, 64% of patients had stable or decreased primary tumor size. Radiographically, two patients appeared potentially resectable, and seven others developed evidence of metastatic disease. Eight patients underwent exploration, but only five could be resected. Of the five patients resected, only one had negative margins and negative lymph nodes. This patient had significant pancreatitis on initial exploration. After neoadjuvant therapy, he had a complete response radiographically, and there was no residual cancer in his resection specimen. Pathologic examination of the other resection specimens suggested that despite significant tumor fibrosis, malignant cells persist even at the periphery of the lesions. CONCLUSION: Although neoadjuvant chemoradiation has many theoretical advantages in managing pancreatic malignancy, true pathologic downstaging of locally advanced lesions into tumors that can be removed with negative nodes and margins appears to be a rare event with currently used therapeutic regimens.

Adenocarcinoma↗
PubMedDate not supplied

Desflurane potentiates atracurium in humans: a comparative study with isoflurane.

STUDY OBJECTIVE: (1) To evaluate the neuromuscular effects of desflurane and its interactions with atracurium and (2) to compare desflurane and isoflurane in these effects. DESIGN: Sequential entry of informed and consenting patients randomly assigned to receive desflurane (n = 25) or isoflurane (n = 25). SETTING: Operating suite of a county-university medical center. PATIENTS: Fifty adults, ASA physical status I, undergoing elective orthopedic surgery. INTERVENTIONS: Following establishment of steady desflurane or isoflurane anesthesia, at 1.25 minimum alveolar concentration (MAC) exhaled for 15 minutes, a randomly predetermined dose of atracurium (0.05, 0.1, or 0.15 mg/kg) was injected intravenously (IV). At the end of surgery, neostigmine 0.04 mg/kg IV was given to reverse the residual block. The neuromuscular effects of desflurane or isoflurane alone, and the dose-response relationship, time course, and reversibility of the neuromuscular effects of atracurium with either anesthetic, were examined in detail and compared using electromyographic quantification of the response of the first dorsal interosseous muscle to train-of-four (TOF) stimulation of the ulnar nerve. MEASUREMENTS AND MAIN RESULTS: TOF fade and depression of the first response (T1) of the TOF were measured in response to desflurane or isoflurane, atracurium, and neostigmine. Desflurane caused more TOF fade than isoflurane prior to atracurium administration. The TOF ratios were 0.91 +/- 0.02 and 0.98 +/- 0.01, respectively (p < 0.05). For other measured neuromuscular parameters, atracurium-induced depression tended to be greater in the presence of desflurane than in the presence of isoflurane, but none of the measured differences reached the statistical significance level of p < 0.05. The ED50, ED95, and 25-75% recovery index of atracurium were 0.038 mg/kg (95% confidence level; range 0.030 to 0.047 mg/kg), 0.11 mg/kg (0.095 to 0.14 mg/kg), and 31 +/- 4 minutes (means +/- SEM) with desflurane anesthesia, versus 0.043 mg/kg (0.035 to 0.052 mg/kg), 0.13 mg/kg (0.11 to 0.16 mg/kg), and 23 +/- 4 minutes with isoflurane anesthesia (p = 0.1-0.2). Continuation of either anesthetic at 1.25 MAC prevented complete recovery of neuromuscular functions spontaneously or following neostigmine 0.04 mg/kg. CONCLUSION: In ASA physical status I adults, 9% desflurane has neuromuscular effects equal to or slightly in excess of those of 1.6% isoflurane.

Adolescent↗
PubMedDate not supplied

Resolution limitations in intravascular ultrasound imaging.

Interest in the use of ultrasound to characterize the structure and composition of blood vessel walls has risen dramatically as a result of the development of intravascular ultrasonic imaging transducers mounted on the tips of small-diameter catheters. A study of the resolution of these transducers is needed to understand the limitations in the visualization of these structures. Theoretic and experimental studies of the resolution of the two principal designs of intravascular ultrasonic transducers, the mechanically scanned single element and the multielement circular array, were carried out. Comparisons of the two designs reveal that they have similar resolutions. However, the resolutions in two of the three dimensions are shown to decrease linearly with increasing radial distance. Significant errors in image interpretation, particularly in larger diameter vessels, will result if this variation in resolution is not accounted for.

Blood Vessels↗
PubMedDate not supplied

Spontaneous spinal cerebrospinal fluid leak and intracranial hypotension.

A case of intracranial hypotension with spontaneous cerebrospinal fluid (CSF) leak was reported. A Tc-99m diethyltriaminepentacetic acid radionuclide cisternography (RNC) showed the accumulation of radioactivity in the area of the subarachnoid space, the poor migration of the isotope over the convexities, and the early appearance of kidney and bladder activity. To localize the site of CSF leak, RNC will be the choice, and when the time comes, RNC will work well in the location of the leak.

Adult↗
PubMedDate not supplied

Staging of pancreatic cancer before and after neoadjuvant chemoradiation.

Neoadjuvant chemoradiation therapy is used at many institutions for treatment of localized adenocarcinoma of the pancreas. Accurate staging before neoadjuvant therapy identifies patients with distant metastatic disease, and restaging after neoadjuvant therapy selects patients for laparotomy and attempted resection. The aims of this study were to (1) determine the utility of staging laparoscopy in candidates for neoadjuvant therapy and (2) evaluate the accuracy of restaging CT following chemoradiation. Staging laparoscopy was performed in 98 patients with radiographically potentially resectable (no evidence of arterial abutment or venous occlusion) or locally advanced (arterial abutment or venous occlusion) adenocarcinoma of the pancreas. Unsuspected distant metastasis was identified in 8 (18%) of 45 patients with potentially resectable tumors and 13 (24%) of 55 patients with locally advanced tumors by CT. Neoadjuvant chemoradiation therapy and restaging CT were completed in a total of 103 patients. Thirty-three patients with potentially resectable tumors by restaging CT underwent surgical exploration and resections were performed in 27 (82%). Eleven (22%) of 49 patients with locally advanced tumors by restaging CT were resected, with negative margins in 55%; the tumors in these 11 patients had been considered locally advanced because of arterial involvement on restaging CT. Staging laparoscopy is useful for the exclusion of patients with unsuspected metastatic disease from aggressive neoadjuvant chemoradiation protocols. Following neoadjuvant chemoradiation, restaging CT guides the selection of patients for laparotomy but may overestimate unresectability to a greater extent than does prechemoradiation CT.

Adenocarcinoma↗
PubMedDate not supplied

Ectopic expression of reg protein: A marker of colorectal mucosa at risk for neoplasia.

Pancreatic regenerating gene (reg I) messenger RNA is overexpressed within the pancreas following injury and resection. Its level of expression corresponds to the level of cellular dedifferentiation. Human reg I has been localized to chromosome 2p12, and ectopic expression of its mRNA has been found within colorectal tumors. We postulated that colorectal production of reg I might either be a marker for the presence of cancer or define mucosa at risk for development of neoplasia. Using a monoclonal antibody to reg I, regenerating gene protein was histochemically mapped in 56 cases of documented colorectal adenocarcinoma. In sections of colon from normal control subjects no reg I protein was noted, whereas 58.9% of the specimens from cancer patients stained positive for reg I. Although a correlation was noted between reg I staining and Dukes' stage, there was no correlation with histologic grade or 5-year patient survival. In 39 of 55 cancer specimens the transition zone (interface) between the neoplasm and normal mucosa was visualized; 100% of the transition zones contained cells that stained strongly positive for reg I. We conclude that reg I protein is ectopically expressed in colorectal mucosa at the transition zone of colorectal cancer, and occasionally within the tumor itself. Although ectopic reg I expression in colorectal epithelia is not a marker for the presence of carcinoma, it may be a sensitive marker for mucosa at risk for development of neoplasia.

Adenocarcinoma↗
PubMedDate not supplied

Thalamic control of cat lateral suprasylvian visual area: relation to patchy association projections from area 18.

In this study, we examined functional contributions of major subdivisions of the lateral geniculate nucleus to the cat's lateral suprasylvian visual area (LS) in relation to the patchy horizontal distributions of association inputs. Multiple-unit activity driven via the contralateral eye was assessed during reversible blockade of the retinotopically corresponding part of layer A, the C layers as a group, or the medial interlaminar nucleus (MIN). Inactivating each of these targets reduced activity at some cortical sites, with inactivation of layer A having, on average, the largest effect. Activity was rarely abolished by inactivation of a single target, indicating that most LS sites receive multiple inputs. Dependence on layer A was strongly correlated with the horizontal distribution of association inputs from area 18. Closely spaced injections of anatomical tracers into extensive regions of area 18 resulted in patches of terminal label in lateral suprasylvian cortex. Activity inside the patches was relatively dependent on layer A, whereas that outside the patches was not. Dependence on the MIN and layer A were negatively correlated, suggesting that inputs dominated by the MIN and layer A were concentrated in independent sets of patches. These results indicate that the anatomically observed patchy projections reflect the functional consequences of geniculate lamination. The A layers are high-acuity relays, whereas the MIN is probably a specialization for dim-light vision (Lee et al., 1984; Lee et al., 1992). We propose that the partial overlap of inputs dominated by the A layers and the MIN allows dynamic shifts in their relative contributions to LS responses, optimizing the balance of high-acuity and high-sensitivity channels over a wide range of illumination conditions.

Anesthetics, Local↗
PubMedDate not supplied

Thalamic control of cat area-18 supragranular layers: simple cells, complex cells, and cells projecting to the lateral suprasylvian visual area.

The goal of this study was to determine the effects of inactivating layer A or the C layers of the cat lateral geniculate nucleus on the supragranular layers of area 18, including cells antidromically activated from the lateral suprasylvian visual area (LS). Isolated cells were visually driven via the contralateral eye while the retinotopically corresponding regions of layer A or, in some cases, the C layers were reversibly inactivated with injections of cobaltous chloride. Simple cells were frequently encountered and were on average more dependent upon layer A than were complex cells, a result qualitatively similar to that found previously in area 17 (Malpeli, 1983; Malpeli et al., 1986). However, the influence of the C layers on area 18 was much more apparent than for area 17. In area 18, as in area 17, the dependence of simple cells on particular geniculate layers appears to follow the terminal patterns of the major direct geniculate inputs. Those simple cells most dependent on layer A were located in lower layer 3. Simple cells in upper layer 3, like complex cells, showed little dependence on layer A, but were strongly dependent upon the C layers. All cells antidromically activated from LS were simple cells with rapidly conducting axons. They had, on average, the same moderately strong dependence on layer A as the patches of LS receiving area 18 input (Lee et al., 1997), supporting the conclusion that the influence of layer A in these patches is largely transmitted via association inputs from area 18. These results demonstrate that simple cells play a major role in association pathways.

Animals↗
PubMedDate not supplied

An antibody that recognizes a determinant common to S and s-bearing sialoglycoproteins.

We describe an antibody, made by an individual of the phenotype M+, N+, S+, s+, U+, that reacted only with ficin or papain-treated red blood cells, and that initially appeared to have anti-S specificity. However, further studies revealed that the antibody, which did not have anti-U specificity, recognized a determinant present on S+, s-, U+, and S-, s+, U+, but missing from S-, s-, U-, and S-, s-, U+, red blood cells. The specificity of this antibody is discussed in terms of current knowledge of the structure of the Ss sialoglycoprotein.

Aged↗
PubMedDate not supplied

Oocyte maturation and embryonic failure.

Embryonic development is readily compromised by imperfections introduced during the process of oocyte maturation. We discuss the nature and causes of these imperfections, particularly in oocytes exposed to inappropriate hormonal regimes in vivo or to culture systems designed to induce the maturation of oocytes in vitro. The acquisition of developmental competence involves the synthesis and storage of a wide range of molecules during oocyte growth followed by the reprogramming and ordered utilization of these stored products during maturation, fertilization and early embryogenesis. The regulatory signals for these molecular changes are produced by the follicle cells in response to circulating levels of gonadotrophins; we report that some ovarian stimulation protocols distort these signals thereby disrupting molecular reprogramming of the oocyte and reducing subsequent developmental competence. The aspiration of immature oocytes from antral follicles followed by their maturation in vitro is a potential alternative to hormonal stimulation of patients in IVF treatment. Although relatively successful in a variety of animals, the production of fully viable human embryos by in-vitro maturation is still unsatisfactory despite the use of a wide variety of culture protocols. Our data suggests that the key to maturation and embryo viability in vitro resides in the follicle cell compartment rather than the oocyte. Because of rapid luteinization changes, follicle cells in culture probably fail to provide the maturing oocyte with the necessary ordered set of instructive signals and nutrients needed for the acquisition of developmental competence. Although much remains to be discovered about the nature, concentration and transmission of signals, nevertheless it is already clear that different steroids, matrix metalloproteinases and growth factors are involved in conferring viability on the maturing oocyte. Major improvements in the yield of viable embryos from in-vitro matured oocytes can be anticipated from a systematic analysis of somatic signals from the pre-ovulatory follicle.

Animals↗