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Biomedical subjects

D M Thomas

Publications and source records attributed to D M Thomas.

At least 91 records · Page 5Linked to original sources
PubMed1989

Dysplasia and carcinoma in the rectal stump of total colitics who have undergone colectomy and ileo-rectal anastomosis.

From a group of 374 patients with ulcerative colitis who underwent colectomy and ileo-rectal anastomosis between 1952 and 1976, 104 presented for follow-up rectal biopsies over a 5 year period to 1986. These patients have been followed for an average of 28 years since the onset of the disease (range 11-56) and provide a unique model for the study of the development of carcinoma in colitis. A total of 443 biopsies was examined and epithelial morphology assessed according to the classification of Riddell et al. (1983). Five patients developed carcinoma of whom two showed dysplasia in biopsies taken a year or more before the diagnosis; one showed dysplasia 2 months before the appearance of cancer, another synchronous with it, and in the fifth patient dysplasia was not detected. Of 20 biopsies classified as 'indefinite for dysplasia, probably negative', 80% were associated with subsequent resolution, while of nine 'indefinite for dysplasia, probably positive' biopsies, eight (89%) were subsequently associated with either carcinoma (six) or dysplasia (two). The results emphasize the danger of absolute reliance upon dysplasia in assessing individual cancer risk in colitics, appear to demonstrate the usefulness of Riddell's classification and provide additional information on the natural history of dysplasia.

Adolescent↗
PubMed1988

Dynamic phosphorus-31 NMR study of sugar cataract and its prevention in rat lenses with aldose reductase inhibitors.

P31 NMR spectroscopy was used to study dynamic changes in rat lens phosphate metabolites under hyperglycemic conditions. NMR control spectra were collected at 37 degrees C with normal media; NMR spectra were also collected under the same conditions except the normal media was substituted for one containing 30 mM xylose. There was a significant increase in intensity of the sugar phosphate NMR signal as well as a moderate decrease in intensity for the three ATP peaks. In separate experiments normal rat lenses were pre-treated with perfusion media containing the ARIs; either Spiro-(2-fluorofluorene-9,4'-imidazolidine)-2',5'-dione (AL theta 1567) or Spiro-(2,7-difluorofluorene-9,4'-imidazolidine)-2',5'-dione (AL theta 1576) for three hours before changing to a xylose plus ARI media. After overnight perfusion, no appreciable change in the rat lens NMR spectra was found. This NMR observation indicates that lenses can be protected from hyperglycemic stress in the presence of the ARIs AL theta 1567 or AL theta 1576.

Adenosine Triphosphate↗
PubMed1988

Squamous cell carcinoma arising in an odontogenic cyst.

Squamous cell carcinoma arising is an odontogenic cyst is rare, Eversole finding 36 cases in his review of the literature in 1975. Since then, a further 10 have been recorded in the English literature. We now report another case and describe its management. The need to histologically examine all odontogenic cysts is stressed.

Carcinoma, Squamous Cell↗
PubMed1987

Scalp infections in black children: think kerion.

Treatment of tinea capitis consists of a 5-week course of griseofulvin. A 1-week course of a systemic corticosteroid may be considered in addition to griseofulvin therapy to accelerate the subsidence of inflammation in kerion lesions. Kerion is an inflammatory form of tinea capitis which may progress rapidly into a fulminant infection if untreated. This case report underscores the need for prompt recognition and appropriate treatment of this disorder.

Abscess↗
PubMed1985

Invasive bladder cancer treated by radical external radiotherapy.

Fifty-three consecutive, unselected patients with invasive bladder cancer, Stage T2 to T3, treated by radical radiotherapy have been reviewed. Cystectomy was reserved for patients with significant worsening of disease during treatment, histologically confirmed persistent or recurrent invasive tumour after treatment, or patients with intolerable symptoms due to radiation cystitis. In 64% of our patients a favourable tumour response to radiotherapy was seen, while a further 31% showed disease progression either during or on completion of radiotherapy. Cystectomy was performed on 22% of patients, mainly for radiation cystitis, and was not associated with a significant operative mortality rate. The crude 5-year survival rate was 42%. We conclude that radical radiotherapy is as effective as other forms of treatment for invasive bladder cancer, but that there remains a need to identify those bladder tumours destined to respond poorly to radiotherapy at an earlier stage.

Adult↗
PubMed1983

Ventilatory status early after head injury.

The ventilatory status of patients within the first few hours following head injury has not been well established. We prospectively studied 63 patients who presented to an urban trauma center with varying severity of head injury to determine whether any trend toward hypo- or hyperventilation existed within the first two hours following injury. Arterial blood gas analysis done on emergency presentation showed that 14 patients with severe head injury (Glasgow coma scale less than or equal to 4) had mean pH values of 7.29 and mean PaCO2 of 41.86 torr. Twenty patients categorized as moderate head injury (GCS = 5-11) had mean pH values of 7.38 with a mean PaCO2 of 34.1 torr. Twenty-nine patients with GCS greater than or equal to 12 had mean pH and PaCO2 values of 7.4 and 31.8 torr, respectively. These differences in pH and PaCO2 were statistically significant between the GCS groups with mild and severe head injury (P less than or equal to .01 pH), (P = .05 PCO2), and could not be explained on the basis of hypoxemia, blood alcohol level, hypotension, or associated chest injury. It is concluded that patients with severe craniocerebral trauma show an early trend toward hypercapnea and acidosis. Immediate control of airway and assisted ventilation is necessary in order to reduce PaCO2 to optimal levels in patients with severe head injury.

Adult↗
PubMed1983

Characterization of the human immune response to a polysaccharide vaccine from Pseudomonas aeruginosa.

Sera from humans vaccinated with a high-molecular-weight polysaccharide vaccine to Pseudomonas aeruginosa immunotype 1 (IT-1) were analyzed for duration of the immune response, specificity for the IT-1 determinant, and by assessing the immunoglobulin classes elicited. The ability of purified IgG, IgM, and IgA to interact with peripheral blood leukocytes, as well as purified polymorphonuclear neutrophils or mononuclear cells, was also examined in an opsonophagocytosis assay. Levels of antibody to IT-1 remained significantly (P less than 0.001) elevated 21 months after immunization. Responses were generally specific to the IT-1 serotype determinant. Some vaccinees also responded to immunotype 2 and immunotype 5 determinants. IgG, IgM, and IgA serum antibodies were all elicited by vaccination. IgG and IgA were effective opsonins for P aeruginosa. IgM-mediated opsonophagocytosis required complement. Serum IgA was highly effective in conjunction with mononuclear cells in opsonophagocytosis of P aeruginosa, suggesting that these immune components may be capable of protecting neutropenic hosts.

Adult↗
PubMed1983

Fatal systemic herpes simplex virus type 2 infection in a healthy young woman.

A previously healthy 28-year-old woman without historic or anatomic evidence of immunologic defect had a genital herpes simplex virus infection that rapidly progressed to systemic disease, with death 12 days after the onset of illness. Herpes simplex virus type 2 was isolated from the liver and spleen and was also shown by direct immunofluorescence in the liver and spleen, but not in the brain. We have found no previously reported instance of death from this virus in a young adult uncompromised immunologically.

Adult↗
PubMed1982

Emergency presentation of subdural hematoma: a review of 85 cases diagnosed by computerized tomography.

The emergency presentations of 85 patients diagnosed by computerized axial tomography (CT) as having subdural hematomas (SDH) were retrospectively reviewed to identify factors contributing to an early or delayed diagnosis. Sixty-one of 85 patients (72%) were diagnosed within 24 hours of presentation. Forty-five of 57 (79%) with definite history or signs of cranial trauma were diagnosed within 24 hours, while only 16 of 28 (57%) without historical or physical evidence of trauma were diagnosed promptly. Focal neurologic signs were present in 32 of 57 patients (56%) with head trauma and 24 of these patients (75%) had an early CT scan. Twenty-two of 50 patients (44%) with head trauma had skull fractures, but the presence or absence of skull fracture alone did not serve to hasten the diagnosis in this group. In patients without head trauma, 14 of 28 (50%) had focal neurologic signs, with eight of 14 (57%) undergoing CT scan within 24 hours. No patient in this group had an abnormal skull series. Thus despite the immediate availability of CT scanning, a significant number of patients, especially those without history or evidence of head trauma, had a delay in diagnosis exceeding 24 hours. The presence of a focal neurologic sign is a more sensitive indicator of the presence of SDH than is a positive skull series.

Adolescent↗
PubMed1982

Resuscitation and transfer of trauma patients: a prospective study.

Improved outcome for trauma patients is closely linked to adequate early resuscitation and timely transfer of selected patients to trauma treatment centers. To document adequacy of early care of patients transferred to a regional trauma center, we analyzed 100 consecutive patients transferred after early care in a licensed emergency department by a medical doctor. Patients were evaluated in four injury categories: 1) neurologic, 2) chest, 3) abdominal, and 4) orthopedic. Standards promulgated by the American College of Surgeons Committee on Trauma and the American College of Emergency Physicians were applied in each injury category, and percentage of noncompliance with these accepted standards was calculated. Dangerous levels of noncompliance with accepted standards of trauma care were documented. On the average, major departures from accepted standards of early care were found in more than 70% of cases, particularly in the potentially lethal areas of airway acquisition and volume replacement. Implications of these data and an evaluation of corrective measures are discussed.

Adolescent↗
PubMed1982

Lipopolysaccharide and high-molecular-weight polysaccharide serotypes of Pseudomonas aeruginosa.

The serotype distribution of bacteremic and nonbacteremic clinical isolates of Pseudomonas aeruginosa in relation to the Fisher immunotyping scheme, the International Antigenic Typing System (IATS), and high-molecular-weight polysaccharide determinants was investigated. Of 281 bacteremic isolates, 273 (97.2%) were serotyped by one of the seven IATS specificities that correspond to a Fisher lipopolysaccharide/high-molecular-weight polysaccharide specificity. In contrast, these seven serotypes accounted for only 68.5% of the 124 nonbacteremic clinical isolates. Review of the reported serotype distribution of P. aeruginosa isolates in Europe further supported the finding of a limited serotype distribution among bacteremic clinical isolates. Fifteen of the 17 IATS serotypes were found among all of the strains of P. aeruginosa serotyped, an indication that most of the IATS serotypes are present in the United States. Thus, only certain lipopolysaccharide immunotypes of P. aeruginosa occur as clinical bacteremic isolates, and a multivalent, high-molecular-weight polysaccharide vaccine directed at the lipopolysaccharide type determinants of P. aeruginosa has potential usefulness.

Agglutination Tests↗
PubMed1982

Morbidity and mortality in 100 consecutive radical cystectomies.

A personal series of 100 consecutive radical cystectomies performed for bladder cancer is reported. Improvements in operative mortality are discussed in relationship to the development of a management regime for these patients. Attention is drawn to the high operative morbidity associated with this procedure.

Adenocarcinoma↗