An association between Wernicke's encephalopathy and thyrotoxicosis.
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Female↗
Biomedical subjects
D M Williams
Publications and source records attributed to D M Williams.
Acute hyperparathyroidism; a surgically correctable cause of coma.
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Aged↗
The effect of phagocytosis of Candida albicans blastospores on alkaline phosphatase levels in rat polymorphonuclear leucocytes.
The phagocytic function of young polymorphonuclear leucocytes with high levels of leucocyte alkaline phosphatase, which are present in the peripheral blood during an inflammatory response, was compared with that of normal polymorphonuclear leucocytes. Candida albicans blastospores were used as phagocytic targets. The phagocytic index of polymorphonuclear leucocytes with low levels of leucocyte alkaline phosphatase was higher than that of cells with high levels of enzyme. Monitoring of leucocyte alkaline phosphatase levels with increasing times of incubation of leucocytes with the blastospores showed a progressive decline in the level of the enzyme. Thus loss of the enzyme is linked to the phagocytic function, although the mechanism of this dynamic process is unclear.
Alkaline Phosphatase↗
Low infusion rate digital subtraction angiography to predict regional perfusion in hepatic arterial chemotherapy.
Digital subtraction angiography (DSA) with a low injection rate of contrast (0.5 ml/sec) was studied as a means of predicting the regional perfusion of percutaneously placed catheters for hepatic arterial chemotherapy. In 64 hepatic artery catheter placements, conventional injection rate angiography (3-5 ml/sec) and low infusion rate DSA exams were compared to conventional radionuclide perfusion studies performed with Tc-99m-MAA. In 58 of 64 cases (90.6%) the conventional arteriogram correctly predicted the extent of hepatic perfusion, whereas in 63 of 64 cases (98%), the low flow DSA exam correctly predicted hepatic perfusion. The conventional arteriogram correctly predicted the extent of extrahepatic perfusion in 32 cases (50%), with a sensitivity of 100%, but a specificity of only 39.6%. The DSA exam was correct in defining the presence or absence of extrahepatic perfusion in 57 of 64 cases for a sensitivity of 82% and a specificity of 91%. Despite the quantitative difference between the low infusion rate DSA study and the chemotherapy infusion (10 ml/hr), it is a useful tool to assist in the correct positioning of temporary catheters for hepatic arterial chemotherapy.
Angiography, Digital Subtraction↗
Policy at the grassroots: community-based participation in health care policy.
American Health Decisions is a developing social movement that aims to work at the grassroots level to educate people about issues and problems in health care and to promote public involvement in decision making about health policy. The movement offers nurses opportunities to expand their traditional commitment to involving people in decisions about their health. By promoting the development of the movement, nurses can contribute to the creation of a structured process of direct public participation in policy decisions related to health care. Nurses may have a special role to play in the movement by promoting the participation of low-income people.
Community Participation↗
Creation of reentry tears in aortic dissection by means of percutaneous balloon fenestration: gross anatomic and histologic considerations.
PURPOSE: To study the safety and efficacy of percutaneous fenestration in aortic dissection, transmural tears in canine and human aortae were created with conventional angioplasty balloons. MATERIALS AND METHODS: Tears created in the aortae of five living dogs were compared with tears created in postmortem specimens. Percutaneous fenestration was performed in a woman with acute type I dissection and ischemic hepatitis who died in multisystem failure, and the balloon tear was documented at autopsy. Additional tears in the human aorta were studied in necropsy specimens of normal, Marfanoid, atherosclerotic, and acutely and chronically dissected thoracic and abdominal aortae. RESULTS: In the canine aorta, transmural balloon tears resulted in rapid death of all five animals, and the tears were approximately 10% longer than tears created post mortem with the same balloon. In human aortic specimens, most transmural and all transseptal tears were linear and were oriented nearly perpendicular to the longitudinal axis of the aorta. Tears that were initiated near calcified plaques or large aortic branches extended in unpredictable directions. The transverse orientation of the tears coincided with the long axis of smooth muscle cells in the media of the intact aorta or the dissection septum. CONCLUSION: Percutaneous balloon fenestration, when performed in areas of the aorta relatively free of atherosclerosis, results in transverse tears in the aortic dissection septum. Percutaneous fenestration of the aortic dissection septum appears feasible and should be considered as a treatment option in carefully selected cases of aortic dissection with ischemic complications. A final conclusion regarding the safety and efficacy of percutaneous fenestration undertaken to relieve organ ischemia requires further clinical experience.
Aged↗
Canine model of acute aortic rupture: treatment with percutaneous delivery of a covered Z stent--work in progress.
PURPOSE: To develop a percutaneous treatment for aortic rupture with use of a covered intraluminal stent. MATERIALS AND METHODS: A transmural tear was created percutaneously in the thoracic aorta in six dogs with use of a 4-mm angioplasty balloon. Gianturco Z stents were covered with polytetrafluoroethylene, loaded into a 14-F sheath, and advanced through the femoral artery to the site of injury. Within 2 minutes after initiation of the injury, the stent was deployed. Homologous canine blood was given during the procedure. Dogs that survived 24 hours were then killed. RESULTS: The first stent did not expand completely, and the dog died in 1 hour. At necropsy, the first two dogs (1-hour and 8-hour survival) had a large left hemothorax and extensive periaortic hematoma, indicating intrathoracic exsanguination. The next four dogs were treated with a modified stent and survived 2 hours (n = 1), 8 hours (n = 1), and 24 hours (n = 2). At necropsy hemothorax did not exceed 15 mL, and periaortic hematomas were small. The cause of death in the two early casualties with the modified stent is uncertain. There were no signs of spinal cord injury despite occlusion of three pairs of intercostal arteries. CONCLUSION: The covered Z stent (in its modified form) tamponaded the aortic tear, preventing exsanguination. Long-term studies of biocompatibility of this device appear justified.
Acute Disease↗
Percutaneous feeding tube placement in pediatric patients: immediate and 30-day results.
PURPOSE: To evaluate fluoroscopically guided percutaneous feeding tube placement in pediatric patients. MATERIALS AND METHODS: Sixty-one procedures were performed. Periprocedural care protocol was changed after patient nine. Forty-eight-hour and 30-day outcomes were assessed. RESULTS: Almost 97% of procedures were successful. The 48-hour major and minor complication rates were 1.9% and 9.6%, respectively, after the initial nine procedures. Risk factors for early complications were the use of the initial care protocol (P < .01) and patient weight below the 50th percentile (P < .05). Major and minor 30-day complication rates were 8.3% and 12.0%, respectively. Risk factors for delayed complications were placement of a gastrojejunostomy tube rather than a gastrostomy tube (P < .05) and immunosuppression (P < .05). CONCLUSION: Percutaneous feeding tubes can be placed in children with a high rate of technical success. Optimal results require attention to periprocedural care. Morbidity is common during the first month of tube use.
Child↗
The dissected aorta: percutaneous treatment of ischemic complications--principles and results.
PURPOSE: Describe the principles and results of percutaneous treatment of ischemic complications of aortic dissection. MATERIALS AND METHODS: Twenty-four patients with aortic dissection complicated by ischemic compromise of the liver or bowel (n = 15), kidney (n = 18), or lower extremity (n = 13) were evaluated by means of aortography, intravascular ultrasound, and manometry, and were treated percutaneously. Visceral arteries were classified as obstructed or nonobstructed. Obstruction was classified as static, in which the dissecting hematoma extended into and narrowed the lumen of a branch artery, or dynamic, in which the dissection flap prolapsed into the vessel origin or narrowed the true lumen (TL) above it. Treatment consisted of vascular stents alone (n = 4), or balloon fenestration (n = 20) without (n = 8) or with (n = 12) vascular stents. RESULTS: Obstruction was present in 77 arteries and was static in 12 arteries, dynamic in 45 arteries, static and dynamic in 17 arteries, and indeterminate in three arteries. Percutaneous treatment did not alter false lumen (FL) pressure, but reduced the peak systolic interluminal pressure gradient from 28 mm Hg to 2 mm Hg and restored flow in 71 of 77 arteries (92%). Six patients died within 30 days (25% operative mortality), none as a result of the procedure. Two additional patients died in follow-up from complications of an expanding FL. Technical complications in two patients due to altered hemodynamics after initial intervention were recognized and corrected percutaneously during the same procedure. CONCLUSIONS: Percutaneous fenestration and endovascular stent deployment are indicated to restore blood flow to arteries compromised by aortic dissection. The prognosis of patients is related to the ischemic injury sustained prior to the percutaneous interventional procedure and, in patients with acute type I dissection who have not undergone surgery, to the preoperative stability of the FL.
Adult↗
An evaluation of smoking cessation-related activities by pharmacists.
OBJECTIVES: To (1) describe the types of smoking cessation intervention activities performed by community pharmacists and (2) assess the perceived barriers to this type of intervention. DESIGN: Confidential mail questionnaire. SETTING AND PARTICIPANTS: 541 community pharmacists in North Carolina and 946 community pharmacists in Texas. RESULTS: North Carolina and Texas differ with respect to the sale of cigarettes at the practice site, with North Carolina pharmacies being more likely to sell tobacco products. Overall, 555 (92.5%) respondents reported that they do not routinely ask new patients if they smoke or use tobacco products. Pharmacists described themselves as knowledgeable about smoking cessation therapies, and 42% of respondents had attended an educational program on smoking cessation. A total of 230 (39.5%) reported consistently counseling individual patients about smoking cessation treatment strategies on at least a weekly basis. Exploratory factor analysis identified four dimensions of barriers that inhibit pharmacists from engaging in smoking cessation-related activities: (1) pharmacist interpersonal characteristics, (2) practice site considerations, (3) patient characteristics, and (4) financial concerns. CONCLUSION: Pharmacists have an opportunity to identify health risks and counsel patients about disease-preventing lifestyle changes. These findings suggest that although pharmacists believe they are qualified to perform smoking cessation interventions, they do not routinely identify smokers and they perceive several barriers to participating in such activities. Pharmacists should investigate increased involvement in smoking cessation activities for the benefit of their patients and for the potential professional and economic rewards.
Community Pharmacy Services↗
Successful control of hepatitis B surface antigenemia in a dialysis unit without geographic or machine isolation.
Persistent hepatitis B infections among patients and frequent new hepatitis B infections among both patients and staff were a major problem in our dialysis unit during its first two and one-half years of operation. During this time the mean quarterly rate of conversion to HBsAg positivity among patients ranged from 0-60% (mean 12%); in staff it ranged from 0-13%. Control efforts, including strict temporal isolation, improved sanitary measures, and use of parallel plate dialyzers without geographic or machine isolation, were begun late in 1976. After a four-month lag, new HBsAg conversions ceased among the 30 patients and staff at risk, despite continued dialysis of eight HBsAg-positive patients (at least four of whom were HBeAg-positive). Over the succeeding three years the conversion rate was zero in both patients and staff. This experience suggests that conservative control measures without geographic separation of patients may be sufficient to control an established outbreak of hemodialysis-related hepatitis B. Controlled prospective trials of this hypothesis are warranted.
Cross Infection↗
Autologous keratinocyte grafting: a new technique for intra-oral reconstruction.
Oral keratinocytes have been grown in sheets in the laboratory from small oral biopsies from four patients undergoing reconstructive oral surgery. These sheets have been successfully applied to mucosal surfaces and good clinical results obtained, with accelerated healing of mucosal defects. These results indicate that keratinocyte grafts can be used in mucosal sites, and may have applications as an alternative to skin grafts in the mouth.
Aged↗
Aplastic anemia associated with parenteral chloramphenicol: review of 10 cases, including the second case of possible increased risk with cimetidine.
A case of aplastic anemia quickly followed therapy with intravenous chloramphenicol and cimetidine and rapidly resulted in death. This is the second such case reported and the 10th case of fatal aplastic anemia complicating therapy with parenteral chloramphenicol. The patient died 19 days (and the previously reported patient 18 days) after the initiation of intravenous therapy with chloramphenicol and cimetidine; the interval from the start of treatment to death was 414 +/- 683 days (mean +/- SD) in the total of nine evaluatable cases of aplastic anemia following parenteral administration of chloramphenicol. Chloramphenicol and cimetidine, each a rare cause of aplastic anemia, should be used--separately or together--with caution. The case described herein is consistent with reports of liver disease, uremia, or bone marrow dysfunction influencing the toxicities of these drugs. The potential for aplastic anemia must be considered whenever chloramphenicol is used, regardless of the route of administration.
Anemia, Aplastic↗
Combination therapy of experimental histoplasmosis and cryptococcosis with amphotericin B and ketoconazole.
Combinations of amphotericin B and ketoconazole had an additive effect in vitro against Histoplasma capsulatum and Cryptococcus neoformans; ketoconazole combined with flucytosine exerted an indifferent effect against C. neoformans. In vivo studies in athymic nude (nu/nu) mice and their heterozygous (nu/+) littermates demonstrated that treatment with the ketoconazole-amphotericin B combination resulted in longer survival of mice with cryptococcosis than did treatment with ketoconazole plus flucytosine. However, mice given ketoconazole plus amphotericin B did not survive significantly longer than those given amphotericin B alone (cryptococcosis) or ketoconazole alone (histoplasmosis). Combination chemotherapy with ketoconazole and amphotericin B may offer a modest therapeutic advantage over therapy with either drug alone.
Amphotericin B↗
Role of cell-mediated immunity in chlamydial infection: implications for ocular immunity.
Cellular immunity to Chlamydia trachomatis is not well understood. Studies with the mouse pneumonitis agent in a mouse pneumonia model suggest a strong thymic component to immunity and a role for the macrophage as an effector cell in cell-mediated immunity to C. trachomatis. Experiments with Chlamydia psittaci indicate that cellular cytotoxic mechanisms and biostatic or cytotoxic mechanisms involving cytokines may also play a role in host defense against chlamydiae. Interferon has been shown to inhibit intracellular growth of both C. trachomatis and C. psittaci in vitro. Further studies are needed on the role of T lymphocytes or lymphokines and macrophages in limiting the growth of C. trachomatis in conjunctival epithelial cells (the most appropriate target cells) and in exerting a toxic effect on these cells. The evidence suggests that macrophages are activated during C. trachomatis infection; this activation may lead to the release of monokines (such as interleukin 1) that may be important in the pathogenesis of scarring due to over-stimulation of cellular immunity during ocular infection. Cell-mediated immunity to ocular infection with C. trachomatis may thus be a double-edged sword.
Animals↗
Determination of liver volume from CT scans using histogram cluster analysis.
The histogram cluster analysis procedure (HICAP), which was developed by NASA for processing satellite images, classifies images into discrete clusters of pixels according to one or more arbitrary imaging variables. We incorporated this nonparametric, multivariate procedure in a semiautomatic computer algorithm for calculating total liver volume from CT scans and compared its performance with that of a human observer. Total liver volumes were calculated from CT scans in adult patients by the algorithm and by an experienced radiologist using the trackball controlled cursor at the CT console. Variability in the computer calculated volumes was determined by repeating calculations three times over the course of 3-12 months. Using HICAP in the univariate mode, we calculated total liver volumes from 28 contrast enhanced CT scans in 27 patients. Liver volumes calculated by the semiautomatic and manual methods had a median absolute difference of 3.6% (Vcomputer = 1.08 * Vmanual - 99.52 cc; r2 = 0.99). Median day-to-day variability of the computer calculated volumes was 1.9% (95% confidence interval: 1.3-2.7%). Using HICAP in a bivariate mode to illustrate its ability to incorporate two image features in one analysis, we studied an additional patient and compared total liver volume calculated from the univariate data set defined by the contrast enhanced CT scan with that calculated from the bivariate data set defined by nonenhanced and contrast enhanced CT scans. The HICAP errors were 4.1% in the univariate analysis and 0.4% in the bivariate analysis. It is concluded that this statistical clustering algorithm provides a clinically accurate, repeatable, and feasible method of in vivo liver volume determination.
Adult↗
Independent origin of the hepatic and splenic arteries from the abdominal aorta: CT demonstration.
PURPOSE: The purpose of this work was to illustrate the CT appearance of the independent origin of the hepatic and splenic arteries from the abdominal aorta. METHOD: A retrospective review of available scans from 159 consecutive contrast-enhanced abdominal CT examinations was undertaken to document the frequency with which this vascular variant is seen at helical CT. RESULTS: Independent origin of the hepatic and splenic arteries was seen in 2 of 159 examinations (1.3%). This correlates well with the 1% incidence reported in the angiographic and surgical literature. CONCLUSION: Independent origin of the hepatic and splenic arteries from the aorta should be seen in approximately 1% of abdominal CT examinations. Knowledge of this vascular variant and its CT appearance may prevent confusion or mislabeling.
Aorta, Abdominal↗
Ambulatory blood pressure responses and the circumplex model of mood: a 4-day study.
BACKGROUND: The relation between mood or emotions and concurrent ambulatory blood pressure responses holds both fundamental and clinical interest. METHODS: The primary sample consisted of 69 normotensive or borderline hypertensive but otherwise healthy adult males. The validation sample consisted of 85 healthy male undergraduate college students. Both samples underwent half-hourly 24-hour ambulatory blood pressure measurements on four separate workdays, 1 week apart. At each ambulatory measurement, subjects recorded their behavior, environment, and mood. The circular mood scale, a circular visual analogue scale based on the circumplex model of mood, was used to reflect the totality of a participant's affective state space. Longitudinal random effects regression models were applied in the data analysis. RESULTS: The results for both samples were quite similar. Sleep and posture had the greatest influence on ambulatory blood pressure and heart rate. The effects of the environmental setting, social setting, and consumption were modest but statistically significant. Independent of these covariates, mood exerted a significant effect on blood pressure and heart rate. Relative to the "mellow" default category, blood pressure increased both for "anxious/annoyed" and "elated/happy" and decreased during "disengaged/sleepy" mood. The range of mood-related blood pressure estimates was 6.0/3.7 mm Hg. CONCLUSIONS: The pattern of blood pressure responses suggests that they were related to the degree of engagement of a mood rather than the degree of unpleasantness. The hypothesis that posits that negative affect-related cardiovascular reactivity mediates the observed correlation between negative affect and disease risk should be reconsidered.
Adolescent↗