Assessment of coronary microcirculation in cardiac allografts. a comparison of intracoronary physiology, intravascular ultrasound and histological morphometry.
Explore the source record for details and available documents.
Journal Article↗
Biomedical subjects
C Salas
Publications and source records attributed to C Salas.
Vaginal papillary carcinomas with transitional cell differentiation: a morphological variant of squamous cell carcinoma?
Explore the source record for details and available documents.
Aged↗
Successful linkage of medical care and community services for HIV-positive offenders being released from prison.
Human immunodeficiency virus (HIV) infection is more prevalent among the incarcerated than the general population. For many offenders, incarceration is the only time that they may access primary care. Project Bridge is a federally funded demonstration project that provides intensive case management for HIV-positive ex-offenders being released from the Rhode Island state prison to the community. The program is based on collaboration between colocated medical and social work staff. The primary goal of the program is to increase continuity of medical care through social stabilization; it follows a harm reduction philosophy in addressing substance use. Program participants are provided with assistance in accessing a variety of medical and social services. The treatment plan may include the following: mental illness triage and referral, substance abuse assessment and treatment, appointments for HIV and other medical conditions, and referral for assistance to community programs that address basic survival needs. In the first 3 years of this program, 97 offenders were enrolled. Injection drug use was reported by 80% of those enrolled. There were 90% followed for 18 months, 7% moved out of state or died, and 3% were lost to follow-up. Reincarceration happened to 48% at least once. Of those expressing a need, 75% were linked with specialty medical care in the community, and 100% received HIV-related medical services. Of those expressing a need for substance abuse treatment, 67% were successful in keeping appointments for substance abuse treatment within the community. Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release. Ex-offenders will access HIV-related health care after release when given adequate support.
Adult↗
Cytomegalovirus esophagitis as a treatable complication of systemic sclerosis.
We report the case of a 51-year-old woman with a connective tissue disease of 8 years duration. She had been taking corticosteroids at a dose of 1 mg/kg/day and azathioprine at a dose of 3 mg/kg/day for 1 month. Given the clinical suspicion of systemic sclerosis (limited form of scleroderma), she was studied according to a protocol including endoscopy to assess the degree to which the underlying disease had affected the gastrointestinal tract. Endoscopy revealed a asymptomatic severe esophagitis and a subsequent biopsy disclosed the presence of cytomegalovirus. Cytomegalovirus pneumonia was also detected. Both processes were successfully managed with intravenous ganciclovir (5 mg/kg/12 hr) for 21 days. This report is a case of cytomegalovirus involving the esophagus in association with systemic sclerosis in a patient immunosuppressed because of drugs that she had been taking. This complication can be asymptomatic and is amenable to treatment.
Journal Article↗
Hodgkin's disease: unsuspected minimal activity in patients that die from causes other than tumoral progression.
Hodgkin's disease (HD) is a curable disease. However, there are still many questions that remain unanswered in this illness, such as the appearance of unsuspected microscopic active illness a long time after the conclusion of treatment, We do not know of any recent publications that have microscopically studied the presence of unsuspected HD activity in patients who died from causes other than tumoral progression. This aspect was analysed in our series of patients with HD. We studied 486 patients with a median follow-up of 8 years. Autopsy was performed in 40 of 144 non-surviving patients. Active HD was found in 60% (24/40) of the patients at autopsy. Of these, 10 patients (25%, 10/40) with active HD died from causes other than tumoral progression. Six patients had minimal clinically unsuspected isolated tumor foci. In spite of technical advances and the introduction of modern and more aggressive chemotherapy, the discovery of minimal unsuspected residual HD continues in an considerable percentage of patients who die from causes other than tumoral progression.
Adolescent↗
The cost-effectiveness of magnetic resonance imaging for investigation of the knee joint.
OBJECTIVES: This study considered the role of magnetic resonance imaging (MRI) in the diagnosis of knee injuries in a district general hospital (DGH) setting. The principal objective was to identify whether the use of MRI had a major impact on the clinical management of patients presenting with chronic knee problems, in whom surgery was being considered, whether it reduced overall costs and whether it improved patient outcome. In addition, the research: (1) explored the 'diagnostic accuracy' of initial clinical investigation of the knee by an orthopaedic trainee, consultant knee specialist and consultant radiologist; (2) considered the variability and diagnostic accuracy of interpretations of knee MRI investigations between radiologists; (3) measured the strength of preference for the potential diagnostic/therapeutic impact of knee MRI (i.e. the avoidance of surgery). METHODS - RANDOMISED CONTROLLED TRIAL: The research was based on a single-centre randomised controlled trial conducted at Kent and Canterbury Hospital. Patients attending with knee problems in whom surgery was being considered were recruited from routine orthopaedic clinics. Most patients had been referred by their general practitioner. Patients were randomised to either investigation using an MRI scan (MRI trial arm) or investigation using arthroscopy (no-MRI trial arm). The study investigated the benefits of knee MRI at two levels: diagnostic/therapeutic impact (i.e. avoidance of surgery) and patient outcome (using the Short Form with 36 items and EQ-5D quality-of-life measurement instruments). Quality of life was assessed at baseline and at 6 and 12 months. Costs were assessed from the perspectives of the NHS and patients. All analyses were by intention to treat. METHODS - SUBSTUDIES (INVESTIGATION OF DIAGNOSTIC ACCURACY): For the investigation of diagnostic accuracy of initial clinical investigation, the sample comprised 114 patients recruited in a separate study conducted at St Thomas' Hospital. The sample was drawn from patients presenting at the Accident and Emergency Department with an acute knee injury. All study patients received an MRI scan, but initial diagnosis was made without access to the scan or the radiologist's report. After 12 months, all clinical notes and MRI scans of study patients were reviewed and a final 'reference standard' diagnosis for each patient was reached. Comparison was made between the diagnosis recorded by each clinician (i.e. orthopaedic trainee, knee specialist and consultant radiologist) and the reference diagnosis. METHODS - SUBSTUDIES (INVESTIGATION OF THE GENERALISABILITY OF RESULTS): For this substudy, the MRI images from 80 patients (recruited at St Thomas' Hospital) were interpreted independently by seven consultant radiologists at DGHs and the St Thomas' Hospital MRI radiologist. For each area of the knee, the level of agreement (measured using weighted kappa) between the responses of the eight radiologists and the reference standard diagnosis was assessed. METHODS - SUBSTUDIES (INVESTIGATION OF PREFERENCES): The investigation of potential patient preferences for the diagnostic/therapeutic impact of MRI was explored using a discrete choice conjoint measurement research design. Choices involved selecting between two alternative scenarios described using four attributes, and data were collected from 585 undergraduate sports science students and analysed using a random-effects probit model. RESULTS - RANDOMISED CONTROLLED TRIAL: The trial recruited 118 patients (59 randomly allocated to each arm). The two groups were similar in important respects at baseline. The central finding was of no statistically significant differences between groups in all measures of health outcome, although a trend in favour of the no-MRI group was observed. However, the use of MRI was found to be associated with a positive diagnostic/therapeutic impact: a significantly smaller proportion of patients in the MRI group underwent surgery (MRI = 0.41, no-MRI = 0.71; p = 0.001). There was a similar mean overall NHS cost for both groups. RESULTS - SUBSTUDIES (INVESTIGATION OF DIAGNOSTIC ACCURACY): The exploration of diagnostic accuracy found that, when compared to orthopaedic trainees (44% correct diagnoses) or to radiologists reporting an MRI scan (68% correct diagnoses), the accuracy rate was higher for knee specialists (72% correct diagnoses). RESULTS - SUBSTUDIES (INVESTIGATION OF THE GENERALISABILITY OF RESULTS): This generalisability study indicated that, in general terms, radiologists in DGHs provide accurate interpretations of knee MRI images that are similar to a radiologist at a specialist centre. The one area of the knee for which this did not hold was the lateral collateral ligament. RESULTS - SUBSTUDIES (INVESTIGATION OF PREFERENCES): The central finding for this substudy was that, on average and within the range specified, choices in this group of potential patients were not significantly influenced by variation in the chance of avoiding surgery. CONCLUSIONS - IMPLICATIONS FOR HEALTHCARE: The evidence presented in this report supports the conclusions that the use of MRI in patients presenting at DGHs with chronic knee problems in whom arthroscopy was being considered did not increase NHS costs overall, was not associated with significantly worse outcomes and avoided surgery in a significant proportion of patients. CONCLUSIONS - RECOMMENDATIONS FOR FURTHER RESEARCH (IN PRIORITY ORDER): (1) The trial data demonstrated that the use of MRI in patients with chronic knee problems reduced the need for surgery. However, the link between diagnostic processes and changes in health outcome is indirect and the finding of no-MRI-related effect on health outcome may, therefore, be a consequence of the limited power of the trial. Further research to confirm (or contradict) these findings would be valuable. (2) The investigation of diagnostic accuracy involved comparison with a reference diagnosis established by a panel of two clinical members of the research team. It would be interesting to explore the extent to which the results would differ using an external panel. (3) The result from the preference study, indicating that the potential diagnostic/therapeutic impact of knee MRI was not highly valued, is a surprising finding that would be important to explore in general public or patient populations. (4) The focus for the trial-based aspects of this research was the DGH and patients presenting with chronic knee problems who were being considered for surgery. Care should be taken in generalising from these results to other patient groups (e.g. acute knee injuries) or to other settings (e.g. specialist centres). Further clinical trials would be required in order to answer such questions.
Adolescent↗
Neutrophilic eccrine hidradenitis unassociated with chemotherapy in a patient with acute myelogenous leukemia.
Explore the source record for details and available documents.
Adolescent↗
The genesis of syringe prescription to prevent HIV in Rhode Island.
Explore the source record for details and available documents.
Blood-Borne Pathogens↗
Spatial learning-induced increase in the argyrophilic nucleolar organizer region of dorsolateral telencephalic neurons in goldfish.
Spatial learning and memory related morphological changes in the argyrophilic nucleolar organizer region (AgNOR) of telencephalic neurons in goldfish were quantitatively evaluated by means of AgNOR neurohistochemical stain. The AgNORs and nuclei of nerve cells of two different telencephalic regions of goldfish trained in a spatial task or submitted to a similar non-contingent behavioral procedure (control group) were morphometrically evaluated. Results show that the area of AgNORs in goldfish dorsolateral telencephalic neurons increased significantly in the spatial learning group but not in control group. This effect seems to be highly specific as it did not appear in the dorsolateral area of the control group neither in the dorsomedial area of both groups. As the size of AgNORs in the nerve cell nuclei reflect the level of transcriptive activity, these morphological changes could be revealing increased protein synthesis in goldfish dorsolateral telencephalic neurons related with learning and memory. These findings could contribute to determining the subregions of the teleost telencephalon implicated in spatial learning and could indicate that the AgNOR staining technique would be a useful tool in assesing learning and memory related neuronal activity.
Animals↗
Reversal learning deficit in a spatial task but not in a cued one after telencephalic ablation in goldfish.
The fish telencephalon seems to be involved in spatial learning and memory in a similar manner to the hippocampus of the land vertebrates. For instance, telencephalon ablated goldfish are impaired in the post-operative retention of a 'spatial constancy' task, which requires the use of mapping strategies, but not in a directly cued task in which responses are based in a guidance strategy. In this regard, previous experiments showed that intact goldfish trained in the spatial constancy task presented considerable behavioral flexibility, as they showed fast reversal learning, that is, they required less training compared with animals trained in the directly cued task and made a lower number of errors to master the reversal than in acquisition. The purpose of the present work was to investigate if the goldfish telencephalon is involved in the faster reversal learning of the animals trained in the spatial constancy task. Goldfish with bilateral telencephalic ablation, sham operated or intact, were trained in the spatial constancy task or in the directly cued task. Telencephalic ablation selectively impaired reversal learning in the animals trained in the spatial constancy procedure. Ablated animals in this procedure reversed more slowly than control animals. By contrast, telencephalic ablation did not produce any significant deficit during reversal in the animals trained in the directly cued task. These results provide additional evidence that the fish telencephalon, as the land vertebrate hippocampus, plays a crucial role in the use of flexible spatial representations.
Animals↗
Hodgkin's disease: correlation between causes of death at autopsy and clinical diagnosis.
PURPOSE: The causes of mortality in Hodgkin's disease patients are insufficiently known. Autopsy study is the fundamental procedure in the investigation of these causes. The present study analyzes the autopsies performed in a series of patients diagnosed as having Hodgkin's disease, determining the cause of death in each case and comparing the premortem clinical data and the postmortem findings. PATIENTS AND METHODS: A total of 486 patients diagnosed as having Hodgkin's disease between 1967 and 1996 were assessed. Autopsy was performed in 40 of the 144 deceased patients (28%). We reviewed the pathological findings, effects of treatment, discordance between the clinical diagnosis and the outcome of autopsy, and cause of death in each case. RESULTS: The most common clinical causes of death in those patients with autopsy study were tumor progression (37%) and infections (43%) in those patients with autopsy study. The rate of discordance between the clinical and autopsy diagnoses in this study was 43%. The most frequent location of residual Hodgkin's disease was in the lymph nodes. CONCLUSIONS: Autopsy study in Hodgkin's disease confirms a high rate of discrepancy between final clinical diagnosis and postmortem lesions despite advances in diagnostic methods. Autopsy revealed causes of death directly related to the treatment, as well as some lesions directly related to patient death and secondary to treatment. Infectious processes are likely to remain undetected and their symptoms can mimic tumor progression.
Adult↗
Dissociation of place and cue learning by telencephalic ablation in goldfish.
This study examined the spatial strategies used by goldfish (Carassius auratus) to find a goal in a 4-arm maze and the involvement of the telencephalon in this spatial learning. Intact and telencephalon-ablated goldfish were trained to find food in an arm placed in a constant room location and signaled by a local visual cue (mixed place-cue procedure). Both groups learned the task, but they used different learning strategies. Telencephalon-ablated goldfish learned the task more quickly and made fewer errors to criterion than controls. Probe trials revealed that intact goldfish could use either a place or a cue strategy, whereas telencephalon-ablated goldfish learned only a cue strategy. The results offer additional evidence that place and cue learning in fish are subserved by different neural substrates and that the telencephalon of the teleost fish, or some unspecified structure within it, is important for spatial learning and memory in a manner similar to the hippocampus of mammals and birds.
Animals↗
Lupus erythematosus with an erythema multiforme-like eruption.
We describe a patient diagnosed with lupus erythematosus (LE) who developed an acute generalized eruption characterized by erythema multiforme (EM)-like lesions. Biopsy specimen showed foci of vacuolar alteration at the dermo-epidermal junction and frequent necrotic keratinocytes. Laboratory tests disclosed a speckled-homogenous antinuclear antibody titer of 1:640, leucopenia and hypocomplementemia. Anti-Ro/anti-La antibodies and rheumatoid factor were negative. Treatment with high-dose oral prednisone and azathioprine led to complete remission of the cutaneous lesions, although eruption recurred two years later. We believe that this patient presented a subacute cutaneous lupus eythematous with a distinctive erythema multiforme-like eruption. This case could be included in the so-called Rowell's syndrome, although it does not fit all the immunological characteristics reported in the original description, as in many of the previously reported cases. At the present time there seems to be enough evidence to classify Rowell's syndrome within the subacute cutaneous lupus erythematosus subset. Finally, a coexistence of LE and EM can not be completely discarded in our patient, although no causative factor was found.
Adolescent↗
[Mixed tumor (pleomorphic adenoma) of head and neck. Typical and atypical patterns].
Pleomorphic adenoma is a benign growth frequently encountered in major salivary glands, although minor salivary glands sometimes can be affected. In the latter non-specific clinical signs allows only the postoperative diagnosis. Nevertheless the existence of lesser salivary glands outside the oral cavity, and therefore pleomorphic adenomas, justify the specialist's need of its knowledge because of the difficulties arising in differential diagnosis. The AA. present a review of 22 cases in various sites treated in their Department in a 9 year-term.
Adenoma, Pleomorphic↗
Vascular permeability factor expression in cerebellar hemangioblastomas: correlation with tumor-associated cysts.
The presence of vascular endothelial growth/permeability factor (VEG/PF) has been studied in histological specimens from a series of 16 cerebellar hemangioblastomas. In this series, the tumors were classified as presenting a macroscopic solid pattern (4 cases), a mainly solid pattern with macroscopic cysts (4 cases) or a mainly cystic pattern (8 cases). Solid tumors showed a low degree (75% of cases) or moderate degree (25% of cases) of VEG/PF positivity. The mainly solid tumors containing macroscopic cysts showed a moderate degree (50% of cases) or high degree (50% of cases) of VEG/PF positivity. Nevertheless, mainly cystic hemangioblastomas showed a high degree (87.5% of cases) or moderate degree (12.5% of cases) of VEG/PF positivity. These findings suggest that the predominance of a cystic or solid macroscopic appearance of cerebellar hemangioblastomas may be influenced by the degree of VEG/PF expression within the tumor tissue.
Cerebellar Neoplasms↗
Granuloma faciale with extrafacial lesions.
Extrafacial involvement in granuloma faciale (GF) is rather exceptional. We report herein a patient with GF associated with lesions on the trunk and the forearm. Histological studies of facial and extrafacial lesions shared similar characteristics: a mixed inflammatory infiltrate with abundant eosinophils in the superficial and middle dermis with a narrow grenz zone of uninvolved dermis between the epidermis and the infiltrate. Evidence of vasculitis was clearly observed in both biopsy specimens. Treatment with dapsone did not alter the course of the disease. We review the 12 cases of extrafacial GF that have been reported in the English and Spanish literature. In these cases a diagnosis of erythema elevatum diutinum (EED) may be suggested. Although GF and EED may share some pathogenic mechanisms, there are several clinical and histological differences between them that make us consider EED and GF as distinct entities.
Adult↗
Expression of vascular permeability factor in craniopharyngioma.
OBJECT: The expression of vascular endothelial growth/permeability factor (VEG/PF) has recently been correlated with the presence of tumor-associated cysts in some intracranial tumors. The purpose of this study was to evaluate a possible relationship between the presence of VEG/PF and the formation of cysts in craniopharyngiomas. METHODS: The expression of VEG/PF was studied in histological specimens from a series of 12 craniopharyngiomas. In this series, the tumors were classified as presenting a mainly solid pattern with small macroscopic cysts (four patients) or a mainly cystic pattern (eight patients). The mainly solid tumors containing small macroscopic cysts showed little or no VEG/PF positivity, which was mainly present in tumor cells surrounding cysts. Nevertheless, mainly cystic craniopharyngiomas showed a moderate or high degree of VEG/PF positivity in tumor cells. CONCLUSIONS: These findings indicate that the predominance of a cystic or solid macroscopic appearance of craniopharyngiomas may be influenced by the degree of VEG/PF expression within the tumor cells.
Adult↗
A method for measuring eye movements using Hall-effect devices.
A system for precise recording of eye position and movements in laboratory animals, by means of Hall-effect devices, is described. The system, useful in neurophysiological and neurobehavioral studies, allows the analysis of saccadic eye movements, optokinetic- and vestibular-induced nystagmus, slow tracking movements, eye vergences, and so forth. This small, light-weight, and inexpensive system uses a set of Hall-effect devices and associated electronics to sense variations in the position of high-power magnets fixed in the eye sclera or in scleral contact lenses. The output of the Hall-effect devices is amplified by operational amplifiers, collected through an A/D converter, and analyzed in a PC computer by specific software.
Animals↗