The S-shaped ductus arteriosus.
Explore the source record for details and available documents.
Ductus Arteriosus↗
Biomedical subjects
D L Brown
Publications and source records attributed to D L Brown.
Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes.
We sought to determine the contemporary frequency of seizures, and the associated cardiovascular changes, resulting from local anesthetic-induced seizures in all patients undergoing brachial plexus, epidural, and caudal regional anesthetics. We investigated the following variables: development and treatment of seizure or cardiac arrest during the regional anesthetic, type of anesthetic (including local anesthetic used), gender, age, ASA physical status class and type of operation (elective or emergent). In addition, each patient who experienced a seizure underwent retrospective review of the acute event to determine the arterial blood pressure and heart rate changes accompanying the seizure, as well as details of the regional block technique. There was a significant difference between the rate of seizure development between epidural, brachia, and caudal anesthetics, with caudal > brachial > epidural. A significant difference was also noted in the rate of seizure development within types of brachial block, with supraclavicular and interscalene > axillary. No adverse cardiovascular, pulmonary or nervous system events were associated with any of the seizures, including the 16 patients who received bupivacaine blocks. The frequency of local anesthetic-induced seizures stratified by block type has a wide range, and cardiovascular collapse after bupivacaine-associated seizure has a low incidence.
Adult↗
Absence/hypoplasia of tibia, polydactyly, retrocerebellar arachnoid cyst, and other anomalies: an autosomal recessive disorder.
Absence or hypoplasia of the tibia has been reported to occur as an isolated hereditary malformation as well as a feature of several autosomal recessive and autosomal dominant syndromes. We report three sibs with absence or hypoplasia of the tibia in association with other malformations whose parents are first cousins once removed. These infants appear to have a "new" autosomal recessive syndrome.
Abnormalities, Multiple↗
Combined clozapine and electroconvulsive therapy for the treatment of drug-induced psychosis in Parkinson's disease.
Drug-induced psychosis is a serious late complication of Parkinson's disease (PD) that requires aggressive treatment. Recent studies have found clozapine a highly effective and ECT a possibly useful intervention. Two cases are presented that illustrate a possible treatment role for ECT. The cases demonstrate that ECT has significant but short-lived antipsychotic effects when used alone. However, patients who do not respond to clozapine monotherapy can be given adjunctive treatment with ECT. The combination therapy resulted in abrupt alleviation of psychotic symptoms in one of the cases, and maintenance with low-dose clozapine allowed for long-term efficacy. On the basis of these findings, a therapeutic approach to patients with drug-induced psychosis in PD is suggested.
Antiparkinson Agents↗
Sonographic appearance of placental villous hydrops associated with Beckwith-Wiedemann syndrome.
Explore the source record for details and available documents.
Adult↗
Uhl's anomaly of the heart mimicking Ebstein's anomaly in utero.
Explore the source record for details and available documents.
Adolescent↗
Improved programs for the affected-pedigree-member method of linkage analysis.
The affected-pedigree-member (APM) method is a non-parametric method of linkage analysis, which requires no assumptions about how the trait of interest is inherited [Weeks and Lange, 1988, 1991, 1992; Lange and Weeks, 1990; Weeks et al., 1992]. The APM method uses only the affected members of each pedigree who are typed for the marker(s). Based on the affected members' marker genotypes and the relationships of the affecteds to each other, the APM method computes a statistic which provides a measure of marker similarity. If the affected members are significantly more similar at the marker locus than expected by chance, then one may conclude that the marker is not segregating independently of the disease. Since the APM method tests a hypothesis about marker similarity, and not about recombination between the marker and disease, it makes and requires no assumptions about the mode of inheritance of the disease. For this reason, the APM method has been used for complex diseases such as Alzheimer's, breast cancer, and melanoma [Pericak-Vance et al., 1989, 1990; Haile et al., 1990; Hall et al., 1990; St George-Hyslop et al., 1990; Cannon-Albright et al., 1992]. We would like to announce the availability of a much improved version of the APM program package. This version has been improved in several ways, as outlined below.
Bias↗
Role of topoisomerase II in the structural and functional evolution of mitogen-stimulated lymphocyte nuclei.
To examine the role of DNA topoisomerase II (Topo II) in the mitogenic activation of mouse lymphocytes, we applied the Topo II inhibitor VM26 throughout the stimulation period and monitored morphological and functional parameters of lymphocyte activation. Cell viability and the usual increase in cell size were little affected at doses between 0.05 and 0.5 microM. DNA synthesis, however, was already significantly inhibited at 0.05 microM, with RNA synthesis inhibited to a lesser extent. Light microscope autoradiography showed that a smaller proportion of cells entered S phase, with each S phase cell incorporating less [3H]thymidine. In immunofluorescence studies, the nucleolar antigen fibrillarin was reduced, although only minor effects on the snRNP Sm antigen and the internal component labeled by antibody PI1 were observed. At the electron microscope level, nucleoli were remodeled and chromatin became aggregated. At a high dose of VM26 (5 microM), cells showed the expected high levels of apoptosis and strong inhibition in all activation parameters assayed. The results support the hypothesis that the Topo II beta isoform is involved in the very early phases of lymphocyte activation, with function of the Topo II alpha isoform, which is more sensitive to VM26, being required for progression through S phase.
Animals↗
Pulmonary hemorrhage after intracoronary stent placement.
OBJECTIVES: The purpose of this study was to determine the incidence and clinical characteristics of pulmonary hemorrhage after intracoronary stent placement. BACKGROUND: Patients undergoing intracoronary stent placement receive intense anticoagulation to prevent stent thrombosis. Pulmonary hemorrhage during intense anticoagulation is uncommon in other clinical settings but has been diagnosed at our institution after stent placement. METHODS: The clinical records of 88 consecutive patients undergoing intracoronary stent placement at a single tertiary referral center were reviewed for evidence of pulmonary hemorrhage. The diagnosis of pulmonary hemorrhage required bronchoscopic demonstration of fresh blood or thrombus in the airways of patients with sudden onset of hemoptysis, dyspnea or hypoxemia and new pulmonary infiltrates on chest radiograph. RESULTS: Pulmonary hemorrhage was identified in 4 (4.5%) of 88 patients undergoing intracoronary stent placement. Patients commonly presented with dyspnea, hemoptysis, hypoxemia, new pulmonary infiltrates on chest radiograph and excessive prolongation of the activated partial thromboplastin time. Mean onset of symptoms was 31.5 h after the procedure. Three of four patients were treated for presumed cardiogenic pulmonary edema until invasive hemodynamic monitoring revealed normal left ventricular filling pressures. Pulmonary hemorrhage resulted in prolonged admissions in the intensive care unit and hospital. One patient died. CONCLUSIONS: Pulmonary hemorrhage after coronary stent placement was commonly misdiagnosed and was associated with significant morbidity and mortality in our patients. Although its mechanism is unclear, excessive anticoagulation was a likely contributing factor. Clinical trials comparing varying strategies and intensities of anticoagulation may be indicated.
Aged↗
Key factors in improving surgical resources.
The health care environment across the country is undergoing unprecedented uncertainty and change, so it is imperative that hospital leaders develop processes that enhance their organization's ability to adapt to new realities and directions. The key factors in maximizing the utilization of resources to meet community demand involve corporate changes and active support from medical, nursing, professional and support staff. This article describes the methods adopted by one community hospital to improve the utilization of surgical resources, with particular emphasis on the process developed for allocating Operating Room time to support corporate priorities.
Appointments and Schedules↗
Serological screening suggests that adult coeliac disease is underdiagnosed in the UK and increases the incidence by up to 12%.
Because coeliac disease often presents atypically it is underdiagnosed. It is suggested that the detection rate may be increased by 12% if serology is used to identify cases of occult enteropathy. All adults noted incidentally to be R1 anti-reticulin antibody (ARA) positive in the course of routine autoantibody testing of 6532 sera over one year were followed. None of the eight patients with seropositive serum was suspected of having coeliac disease. All eight had high titres of IgA anti-gliadin and IgA anti-endomysial antibodies, neither of which is detected in a routine autoantibody test, in addition to IgA R1-ARA. On clinical review coeliac disease was considered probable in only one patient, but because of the strong serological evidence of gluten sensitivity, jejunal biopsy was advised in all eight. Seven agreed and all had villous atrophy and crypt hyperplasia in keeping with coeliac disease. Six of the seven presented initially with vague symptoms such as tiredness or arthralgia. These symptoms disappeared after several weeks of gluten withdrawal. Forty two sera showing reticulin staining patterns other than R1 were used as controls. Low titre IgA anti-gliadin was noted in two of 42 but none had IgA anti-endomysial antibody. These 42 cases were not recommended for biopsy. During our study 58 other new adult cases of coeliac disease were diagnosed, primarily on clinical rather than serological grounds, at the four hospitals that request autoantibody studies. Occult coeliac disease detected serologically thus increased the overall incidence of coeliac disease by 12% from 58 to 65 cases. R1-ARA, even in the absence of the expected symptoms and signs of coeliac disease, is an indication for jejunal biopsy and is a reliable indicator of occult coeliac disease.
Adolescent↗
Ovarian masses: can benign and malignant lesions be differentiated with color and pulsed Doppler US?
PURPOSE: To determine whether color and pulsed Doppler ultrasound (US) can be used to differentiate benign from malignant ovarian masses. MATERIALS AND METHODS: Forty-four ovarian masses identified with sonography in 40 patients were confirmed at surgery (n = 35) or followed up to resolution with US (n = 9). Color and pulsed Doppler US were used to calculate the lowest pulsatility index (PI) and resistance index (RI) for each mass. RESULTS: Color Doppler US enabled detection of arterial flow in 24 of 36 benign masses and six of eight malignant masses. PI was lower in malignant masses than in benign masses (P = .002), as was RI (P = .001). Both indexes demonstrated overlap between benign and malignant masses; therefore, no cutoff value for either index had both high sensitivity and high specificity for malignancy: For PI cutoff of 1.0, sensitivity and specificity were 100% and 46%, respectively; for RI cutoff of 0.4, 50% and 96%. CONCLUSIONS: While PI and RI tend to be lower in malignant ovarian masses, neither index can be used reliably to differentiate benign from malignant lesions. In addition, lack of detectable flow by means of color Doppler US does not exclude ovarian malignancy.
Adult↗
Tubal rupture in patients with ectopic pregnancy: diagnosis with transvaginal US.
PURPOSE: To determine whether sonography can help diagnose tubal rupture in patients with ectopic pregnancy. MATERIALS AND METHODS: The authors reviewed the transvaginal ultrasound (US) scans and medical records of 132 consecutive patients with tubal pregnancy confirmed at surgery performed within 24 hours of undergoing US. RESULTS: Adnexal masses were seen in 93 patients at US. Thirty-four patients had a tubal ring, and 59 had a complex mass. The frequency of tubal rupture was similar for both groups. The adnexal mass was significantly smaller in patients without a ruptured tube, but there was considerable overlap. Rupture was present in 21% of patients with no sign of or a trace of intraperitoneal fluid, increasing steadily to 63% in patients with a large amount of free fluid. Even though the amount of fluid was the best predictor of rupture, it was not completely reliable, as 37% of patients in whom a large amount of fluid was found had intact tubes. CONCLUSION: No finding at transvaginal US is a reliable indicator of rupture. Contrary to findings from previous studies, the appearance of the adnexal mass, if present, is not related to tubal rupture.
Fallopian Tube Diseases↗
Cervical ectopic pregnancy: results of conservative treatment.
PURPOSE: To review experience with early sonographic diagnosis and fertility-preserving treatment of cervical ectopic pregnancy. MATERIALS AND METHODS: The authors evaluated 12 consecutive cases of cervical ectopic pregnancy diagnosed with ultrasound (US) and treated with methods that successfully preserved the uterus. Gestational age, sonographic findings, means of conception, and method of treatment were recorded. RESULTS: Gestational age at diagnosis ranged from 5.0 to 7.9 weeks. Cardiac activity was documented in nine cases. Patients were treated as follows: transvaginal US-guided injection of potassium chloride into the embryo or gestational sac (n = 6), uterine artery embolization followed by dilation and evacuation (n = 4), dilation and evacuation after ligation of uterine artery branches (n = 1), and uterine artery embolization followed by administration of systemic methotrexate (n = 1). The cervical pregnancy was successfully ablated with one treatment in all cases. No patient required hysterectomy, and only one patient required transfusion. Two patients subsequently delivered healthy babies; three other patients have been able to conceive successfully. CONCLUSION: When cervical ectopic pregnancy is diagnosed early, US-guided termination or other conservative procedures allow preservation of the uterus, thus maintaining potential fertility.
Cervix Uteri↗
Sonography of the fetal posterior fossa: false appearance of mega-cisterna magna and Dandy-Walker variant.
PURPOSE: To establish that incorrect scanning of the fetal posterior fossa may falsely create the appearance of a mega-cisterna magna (MCM) or Dandy-Walker variant (DWV). MATERIALS AND METHODS: After routine sonography, 100 consecutive fetuses (gestational age range, 25-40 weeks) without abnormality underwent additional posterior fossa scanning in an attempt to create the appearance of an MCM (anteroposterior diameter larger than 10 mm) or DWV. Sonograms were obtained in a plane inferior to or angled more coronally than the routine axial plane. RESULTS: The posterior fossa was depicted in 93 fetuses. Pseudo-MCM occurred in 35 (38%) of 93 fetuses: 12 (30%) of 40 fetuses aged 25.0-29.9 weeks, 11 (50%) of 22 fetuses aged 30.0-34.9 weeks, and 12 (39%) of 31 fetuses aged 35.0-40.0 weeks. Pseudo-DWV occurred in 40 (43%) of 93 fetuses: 20 (50%) of 40 fetuses aged 25.0-29.9 weeks, 12 (55%) of 22 fetuses aged 30.0-34.9 weeks, and eight (26%) of 31 fetuses aged 35.0-40.0 weeks. CONCLUSION: Sonography of the posterior fossa in an angled semi-coronal plane should be avoided because it may create an appearance that mimics an abnormality.
Artifacts↗
Distal ureteral calculi: detection with vaginal US.
PURPOSE: To describe the use of vaginal ultrasonography to identify distal ureteral calculi and hydroureter. MATERIALS AND METHODS: Abdominal and vaginal sonography were performed in 13 women with distal ureteral calculi. Indications for sonography included flank pain, hematuria, and suspected appendicitis. Six patients were pregnant. RESULTS: In each patient, vaginal sonograms demonstrated a distal ureteral calculus; in only two cases was the calculus detected with transabdominal sonography. Distal hydroureter was identified with vaginal scanning in each patient but with abdominal scanning in only two. Hydronephrosis was absent in three patients, mild in six, and moderate in four. Symmetric ureteral jets were noted at transabdominal sonography in two of nine patients. Follow-up transvaginal scans obtained shortly after passage of stones in two patients revealed swelling of the trigone but normal ureteral jets. CONCLUSION: In symptomatic female patients, use of vaginal sonography should be considered to evaluate the distal ureter for calculi, particularly if the results of transabdominal examination are normal or inconclusive.
Adult↗
Validation of indirect measures of body fat in lactating cows.
The objective of the study was to establish and compare equations that would estimate the body fat content of lactating dairy cows from different indirect techniques. The techniques used were body condition scoring, dilution of D2O in body water, and determination of mean fat cell size diameter of the subcutaneous, abdominal, and perirenal depots. Each technique was validated against direct determination of body fat content of the same lactating cows. To apply equations to high producing, lactating dairy cows, cows were from a herd producing more than 9500 kg of FCM/305 d, were lactating, and were in less than average body condition. Eight days prior to slaughter, a single injection of D2O was injected into the jugular vein, and body dilution was followed for 4 d. Cows were scored for body condition on the day of injection and weighed daily for the 4 d prior to slaughter. Samples of subcutaneous, perirenal, and omental adipose depots were taken, and adipocyte size and number were determined. Body fat was not predicted well by D2O space alone, but inclusion of BW did improve the prediction of body fat from this variable. The best equations were derived from use of BW with body condition score or subcutaneous fat cell diameter: observed body fat = -122.1 + .21 x BW + 36.0 x body condition score, and -195.6 + .290 x BW + .927 x subcutaneous fat cell diameter; standard errors of the estimate were 4.6 and 5.5 kg, respectively. Equations using diameters of abdominal and perirenal fat cells gave similar relationships. Equations using all four predictors (live BW, fat cell diameter, condition score, and D2O space) were only slightly improved over these equations. Thus, use of body condition score, adipocyte diameter, and BW in laboratory and field conditions may help in the study and management of the use of body fat in lactating dairy cows.
Adipose Tissue↗