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Biomedical subjects

D L Day

Publications and source records attributed to D L Day.

At least 37 records · Page 2Linked to original sources
PubMed1988

Pulmonary fungal infections after bone marrow transplantation.

Of 319 pediatric patients treated with bone marrow transplantation (BMT) during a 10-year period, 27 developed pulmonary fungal infections (PFI). Only 2 patients (7%) survived. Twenty-three patients (85%) had been treated with systemic antifungal therapy immediately before or at the time of diagnosis. Nineteen patients (70%) were neutropenic, and 4 of the 8 patients who were not neutropenic were being treated with systemic steroids for graft vs. host disease (GVHD). Seven patients (26%) died within 7 days of diagnosis. The diagnosis was made ante-mortem in 9 patients (33%). Radiographic abnormalities were variable. At the onset of chest X-ray (CXR) change, the pulmonary infiltrates were unilateral in 14 patients (52%) and, at diagnosis, bilateral in 18 (66%). At diagnosis the infiltrates were interstitial in 3 patients (11%), alveolar in 20 (74%) and mixed in 4 (15%). Six patients (22%) developed cavitary lesions. The infecting agents were Aspergillus in 21 patients (78%), Candida in 7 (26%), Mucormycosis in 3 (11%), and Fusarium in 1 (4%). Five patients (19%) had mixed fungal infections and 7 (26%) had concurrent cytomegalovirus (CMV) pulmonary infections. Although the radiographic changes are often nonspecific in PFI, alveolar or nodular infiltrates in neutropenic patients or in those being treated for GVHD should strongly suggest a fungal etiology.

Aspergillosis↗
PubMed1988

Kidney size at diagnosis of childhood acute lymphocytic leukemia: lack of prognostic significance for outcome.

The prognostic significance of kidney size at diagnosis of acute lymphoblastic leukemia (ALL) was assessed in a population of 142 children. Kidney size was determined using three different methodologies, and its significance was determined by univariate and multivariate life-table methods. Enlarged kidney size (as determined by any of the three methods used) was not associated with an overall poorer survival. These findings were consistent when kidney size at diagnosis was analyzed as a singled variable and when it was considered after adjustment for the known prognostic factors of age, sex, and initial WBC count. Assessment of renal size at the time of diagnosis of childhood ALL is not indicated for the purpose of predicting subsequent prognosis.

Age Factors↗
PubMed1988

Upper abdomen: CT findings following partial hepatectomy.

The appearance on computed tomographic (CT) scans of the upper abdomen after partial hepatectomy is complex. The findings expected at CT should not be confused with those of surgical complications, such as abscess, biloma, or hematoma. The findings on CT scans and the records of 17 patients who had undergone partial hepatectomy for malignancy were reviewed. Operations included wedge resection, left medial and lateral segmentectomies, left lobectomy, right subsegmentectomy, right lobectomy, and extended right lobectomy (trisegmentectomy). When partial hepatectomy had been performed with no complications, findings at CT included a small region of low attenuation at the surgical margin, probably due to transient accumulation of blood and bile; a right pleural effusion; extraluminal gas; shift of abdominal organs; hepatic regeneration; and fat attenuation at the resection margin representing the omental patch placed at surgery. Findings associated with surgical complications--such as abscess, biloma, and hematoma--included large or high-attenuation perihepatic and subphrenic fluid collections that did not conform to the resection margin.

Adolescent↗
PubMed1988

Biliary complications after liver transplantation in patients with preexisting sclerosing cholangitis.

To determine if biliary complications after liver transplantation are more frequent in patients with preexisting sclerosing cholangitis and to clarify the role of interventional procedures in this setting, the authors reviewed all 40 adult cases in which liver transplantation was performed at their institution over a 3 1/2-year period. Biliary complications, particularly strictures at the choledochojejunostomy and debris in the intrahepatic and common ducts, were seen in six of ten liver transplant patients (60%) with preexisting sclerosing cholangitis; this is six times the frequency of biliary complications seen in other adult recipients (10%). Biliary complications were definitively diagnosed and managed with interventional radiologic procedures. Obstruction due to anastomotic strictures required treatment with balloon dilation in all six of the affected patients. Obstructive biliary complications occur in many liver recipients with preexisting sclerosing cholangitis. These complications require aggressive radiologic assessment and intervention but to date have not adversely affected survival.

Adult↗
PubMed1988

Imaging of vascular complications after hepatic transplantation.

Vascular complications after hepatic transplantation can compromise graft and patient survival. Angiography defines the need for revascularization or retransplantation, but the value of noninvasive imaging in this setting is not clear. To assess the relative merit of noninvasive imaging techniques (sonography, scintigraphy, CT, and MR), we retrospectively reviewed 19 major vascular complications that occurred in 15 of 98 hepatic recipients over a 3 1/2-year period. Portal venous thrombosis was seen in seven patients, donor aortic or hepatic arterial thrombosis in seven, and inferior vena caval thrombosis in five. Sonography provided the initial diagnosis of portal venous thrombosis in three, arterial compromise in five, and caval obstruction in four. CT was the first diagnostic examination to identify portal occlusion in two, donor aortic thrombosis in one, and inferior vena caval thrombosis in one. Scintigraphy and MR imaging provided complementary data. Both sonography and CT are useful in the evaluation of vascular complications that occur after hepatic transplantation; however, neither is sufficiently sensitive to obviate angiographic assessment.

Adolescent↗
PubMed1988

Pneumatosis intestinalis after bone marrow transplantation.

The clinical and pathologic data in 18 patients in whom pneumatosis intestinalis developed after bone marrow transplantation were reviewed to determine the significance of this finding. The colon, predominantly the right side, was involved in 17 of the 18 cases. Pneumatosis intestinalis developed earlier in the 14 symptomatic patients than in the four asymptomatic patients. Symptoms included diarrhea (12 patients), abdominal pain (six patients), rectal bleeding (two patients), and abdominal distension (two patients). Factors contributing to the development of pneumatosis intestinalis included pretransplantation chemotherapy and radiotherapy, steroid therapy, infectious colitis, graft-versus-host disease, and septic shock. Intestinal disease contributed to the deaths of seven patients with pneumatosis intestinalis, necessitated right hemicolectomy in another patient, and resolved with conservative treatment in 10 patients. In summary, bone marrow transplant recipients with pneumatosis intestinalis may follow either a benign or fatal course, depending on the underlying condition of the patient. Clinical correlation is important in determining the significance of this finding.

Adolescent↗
PubMed1988

Correlation of clinical and pathologic findings in early onset neonatal group B streptococcal infection with disease severity and prediction of outcome.

This study analyzed the clinical characteristics of 69 neonates who were admitted to the University of Minnesota Hospital between January, 1972, and June, 1984, with early onset Group B streptococcal infection (EOGBS) and determined those features associated with fatal infection. The incidence of EOGBS was 1.6 cases/1000 live births among 7960 inborn infants; the mortality rate for inborn and outborn infants was 28%. Multivariate analysis identified five features adequately predicting fatal outcome: birth weight less than 2500 g, absolute neutrophil count less than 1500 cells/mm3, hypotension, apnea and a pleural effusion on the initial chest radiographs. With these five variables and an initial blood pH less than 7.25, a clinical score was constructed that correctly predicted outcome in 93% of patients in this study (87% sensitivity, 95% specificity). Autopsy findings in 16 of 19 infants with fatal EOGBS suggested that surfactant deficiency respiratory distress syndrome was common in preterm infants with EOGBS and contributed to their higher mortality compared with term infants.

Birth Weight↗
PubMed1987

Primary pulmonary rhabdomyosarcoma of the lung in children. Report of two cases presenting with spontaneous pneumothorax.

This report describes two cases of pulmonary rhabdomyosarcoma occurring in children, ages 21 and 30 months at diagnosis. Both patients presented with spontaneous pneumothorax and had cystic changes in the affected lung by chest x-ray. Ultrastructural and immunohistochemical studies supported the myogenic phenotype of these neoplasms. The authors were unable to confirm that either of these tumors had unequivocally originated in a congenital cyst although previous authors have reported this association. An apparent morphologic spectrum of embryonic appearing neoplasms including pulmonary blastoma and a malignant mesenchymoma have been observed in the lungs of children.

Child, Preschool↗
PubMed1987

CT appearance of antibiotic-induced colitis.

Eleven abdominal computed tomographic (CT) examinations were performed in 10 patients with antibiotic-induced colitis. The clinical, endoscopic, and CT findings are presented. The most common CT findings were colonic dilatation and bowel wall thickening. However, small bowel dilation was commonly seen. Intramural gas and ascites were less frequent findings. The diagnosis of antibiotic-induced colitis was rarely made before CT examination. Consequently, attentiveness to these CT abnormalities can expedite specific treatment. When these findings are noted on CT they represent the equivalent of toxic megacolon and administration of rectal contrast is contraindicated.

Adolescent↗
PubMed1987

Phenotypes of HeLa S3 variant cell lines resistant to growth inhibition by sodium butyrate.

HeLa cell variants capable of multiplying in the presence of sodium butyrate were used to study the relationship of cell cycle position to human chorionic gonadotropin (hCG) production and regulation of the genes encoding hCG alpha- and beta-subunits. The butyrate-resistant variants exhibit several different stable phenotypes. In wild-type HeLa cells, butyrate arrests cell division and modulates synthesis of alpha- and beta-subunits of glycoprotein hormones by coordinately regulating steady-state levels of their respective mRNAs. Because the variant cell lines replicate, in addition to producing hCG subunits in the presence of butyrate, cell cycle arrest does not seem to be a requirement for expression of glycoprotein hormone genes. Studies of histone modification suggest that neither hyperacetylation of histones H3 and H4 nor dephosphorylation of histones H1 and H2A mediates inhibition of cell replication. In the variants, alpha-subunit and hCG beta levels are independently regulated, as a consequence of independent regulation of alpha- and beta-hCG mRNA levels. Long-term effects of butyrate include derepression of some genes (hCG beta in the variant AO) and repression of others (hCG alpha in variant AO). Moreover, hormone production correlates with the steady-state levels of mRNA for each of the subunits, suggesting that regulation occurs before translation. These findings indicate that the butyrate-resistant variant cell lines are valuable for studies of the molecular mechanisms involved in regulation of expression of ectopic hormones.

Acetylation↗
PubMed1987

Metastasizing chordoma in early childhood: a pathological and immunohistochemical study with review of the literature.

A 2 1/2-year-old female with a sphenooccipital-vertebral chordoma presented with neck pain, torticollis, fever, a lytic lesion of C2 vertebra, and bilateral nodular infiltrates in the lung. The lung biopsy revealed multiple tumor emboli by an enigmatic epithelioid-appearing neoplasm with immunohistochemical staining for vimentin, cytokeratin, and epithelial membrane antigen. A thorough roentgenographic evaluation disclosed a destructive, prepontine mass in the region of the clivus, erosion of the odontoid process, and compression of the cervical spinal cord. The patient died after a clinical course of 3 months. We identified 16 additional cases of metastasizing chordomas in the pediatric-age population; this case is the first to our knowledge with pathologically documented pulmonary metastasis at presentation.

Bone Neoplasms↗
PubMed1987

Grading of reflux by radionuclide cystography.

Over a three-year period, radionuclide cystography (RC) was performed on 145 patients. Of these, 31 nephroureteral units in 25 patients demonstrated vesicoureteral reflux by RC and also by radiographic cystography (XC). The RC and XC studies were performed within three months of one another. The grading of reflux was determined by RC and then compared with that of XC using the criteria for grading as established by the International Reflux Study Committee (IRSC). Of 18 nephroureteral units in 14 patients with grade II reflux by XC, 14 were similarly graded by RC (78%). Of five nephroureteral units in five patients with grade III reflux by XC, the correlation by RC was 100%. However, when grades II and III were combined into a single category of low-grade reflux, the correlation achieved between the two cystographic techniques was 100%. Of five nephroureteral units in four patients with grade IV reflux by XC, the correlation was 60%, and in three units in two patients with grade V reflux the correlation was 100%. When grades IV and V are combined into a category of high-grade reflux, a correlation of 100% is achieved. When the reflux is graded into the five IRSC categories, the overall unequivocal correlation between the two studies is 80%. However, when only two categories are used (low grade = grades II and III, and high grade = grades IV and V), a correlation of 100% is obtained.

Adolescent↗
PubMed1987

B-cell lymphoproliferative disorders in children after bone marrow transplantation: radiologic manifestations.

The radiographic findings in five pediatric patients in whom unregulated B-cell lymphoproliferative disorders developed following bone marrow transplantation are described. Four patients received T-cell-depleted bone marrow from mismatched donors and one received nondepleted marrow from a matched sibling donor. These disorders are similar to B-cell lymphoproliferative disorders that have been described in other immunosuppressed hosts. They are associated with Epstein-Barr virus and range from polyclonal proliferation without cytogenetic abnormalities to monoclonal lymphoma with clonal cytogenetic changes. Unlike other postallograft lymphoproliferative processes, B-cell lymphoproliferative disorders in these patients have not responded to antiviral therapy, immunologic therapy, or chemotherapy. The radiographic patterns of disease include diffuse or focal hepatic involvement; gallbladder wall thickening; and pulmonary, soft-tissue, and basal-ganglion masses. These radiologic findings are not specific and evaluation of tissue histology is required for diagnosis.

Adolescent↗