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Biomedical subjects

D R King

Publications and source records attributed to D R King.

At least 73 records · Page 4Linked to original sources
PubMed1984

Secondary thyroid neoplasms in pediatric cancer patients: increased risk with improved survival.

Between 1973 and 1983, eight children who had undergone successful multimodal management of malignant tumors developed secondary thyroid neoplasms. The primary tumors were acute lymphocytic leukemia in three, Wilms' tumor in two, and Hodgkin's disease, rhabdomyosarcoma, and ganglioneuroblastoma in one each. During this period, 174 long-term survivors with these five diagnoses were enrolled in our tumor registry, yielding a 4.6% incidence of secondary thyroid neoplasms. All eight patients received both radiation and chemotherapy. The mean radiation dose was 2,700 r with a calculated thyroid dose of 2,140 r (range, 5 to 4,200 r). Age of diagnosis of the primary tumors ranged from 1 to 8 2/12 years (mean, 5 years), and the latent period between treatment and development of the thyroid lesions averaged 6 1/2 years. Thyroid neoplasms presented at an average age of 11 4/12 years. Five patients developed solitary adenomas, one presented with multiple adenomas, and two had follicular carcinoma with regional lymph node metastases. Although thyroid neoplasms are rare in childhood, clinically apparent thyroid tumors have been observed in up to 2.5% of children following radiation exposure (mean follow-up, 24 years). The reported latent period before the development of thyroid neoplasms in irradiated patients is at least 10 years, with the peak incidence occurring 20 to 25 years after exposure. This study documents a 4.6% incidence of subsequent thyroid neoplasms in pediatric cancer patients within a relatively short follow-up period (mean, 11 years). These thyroid tumors occurred at an earlier age (mean, 11.5 years) and with a shorter latent period (mean, 6.5 years) than would be predicted from previous studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1983

Mortality attributable to smoking in New Zealand.

Relative risks for mortality due to various smoking related diseases were derived from a review of the literature on the epidemiology of smoking related illness. These were used, together with the New Zealand 1976 census data on smoking habits and the National Health Statistics mortality data, to derive the proportion of deaths which can be attributed to cigarette smoking. The results indicate that about 15 percent of deaths in New Zealand (3693 deaths annually) are attributable to smoking. This is comprised of 19 percent of all male deaths and 8 percent of all female deaths in 1976.

Adolescent↗
PubMed1983

Antibiotic management of complicated appendicitis.

A prospective, randomized, double-blind clinical trial was undertaken comparing gentamicin, ampicillin, and clindamycin (GAC) to gentamicin, ampicillin, and placebo (GAP) in children with complicated appendicitis. Of the 64 patients enrolled in this study, 33 were assigned to the GAC group and 31 received GAP. A single GAC patient (3%) was considered a therapeutic failure in comparison to seven children (23%) in the GAP group (P less than 0.05). Duration of fever was significantly prolonged in the GAP patients (4.7 +/- .8 days versus 2.9 +/- .5 days) when compared to the clindamycin treated children (P less than 0.05). Duration of leukocytosis was 3.2 +/- .4 days for GAC patients and 4.9 +/- .9 days for those on the GAP protocol (P = 0.08). On the basis of this experience the routine use of gentamicin, ampicillin, and clindamycin is recommended for all children with complicated appendicitis.

Ampicillin↗
PubMed1983

An ultrastructural study of the intimal injury induced by an indwelling umbilical artery catheter.

In an experimental study, catheterization of the abdominal aorta with small umbilical artery catheters consistently produced significant intimal injury. The duration of catheterization varied from 1 hr to 7 days, and recovery periods following catheter removal varied from 1-150 days. Endothelial disruption was observed in all animals sacrificed within 24 hr of catheter removal. Healing progressed rapidly when the duration of catheterization was short, but was protracted with longer periods of catheterization. Thrombi were frequently found adhering to the exposed subendothelial surface. Routine light, scanning, and transmission electron microscopy demonstrated consistent cellular changes, which depended upon the duration of catheterization and the length of recovery periods. A consistent relationship between the degree of intimal injury and the duration of catheterization was observed.

Animals↗
PubMed1981

The pediatric patient with sarcoma.

The results of the treatment of the commonest soft tissue sarcoma in childhood have improved dramatically during the past decade. The combination of reasonable surgery, radiotherapy and multiagent chemotherapy has been demonstrated to provide effective control of both the primary tumor and distant metastases in patients with rhabdomyosarcoma. Similar progress with the less common soft tissue malignancies will be more difficult to attain. Current therapeutic trends appear to favor a similar multimodal approach with a conservative but complete surgical excision combined with varying regimens of radiation and chemotherapy. Because of the infrequent occurrence of these unusual tumors (450 cases per year in the United States) no single institution can possibly attract a significant number of new cases to enter on treatment protocols. Substantial improvement in our current therapeutic techniques will be possible in the future only if our combined multicenter studies are continuously refined, re-examined, and extended. A plea is made for early referral of these difficult patients to regional study centers.

Adolescent↗
PubMed1981

Selective management of injured spleen.

During the past 6 years, 68 consecutive children suffering from splenic trauma have been treated according to a selective management plan. Twenty-two patients (32%) underwent splenectomy, parenchymal repair was performed on 16 occasions (24%), and nonoperative treatment was employed in 30 children (44%). Overall results have been good in all three groups. Two children (3%) died as a result of their injuries, and 10 complications were recorded. Both deaths and 7 of the 10 complications occurred in the patients undergoing splenectomy. By utilization of a basic management plan that favors nonoperative treatment over splenic repair and repair over splenectomy, splenic salvage has been successfully accomplished in 86% of the 49 patients treated since 1977.

Adolescent↗
PubMed1980

An improved method of wound management for pediatric patients.

Polyurethane moisture-vapor permeable film (MVPF), a new product for the management of superficial wounds, was studied in an uncontrolled clinical trial in 50 pediatric patients. MVPF was used in the management of skin graft donor sites, partial thickness burns, traumatic abrasions, decubitus ulcers, intravenous skin sloughs, and a variety of other wounds. Advantages of this material over standard dressing techniques include: more comfort, freedom of motion of the injured part, fewer dressing changes, and apparently faster epithelialization in many cases. Folliculitis, noted in one patient, was the only complication. MVPF is easily adaptable to outpatient wound management, and has gained rapid acceptance by nurses, patients and parents.

Bandages↗
PubMed1980

Hormonal enhancement of technetium-99m pertechnetate uptake in experimental Meckel's diverticulum.

A canine model simulating Meckel's diverticulum was used to evaluate the effects of pentagastrin, glucagon, and a combination of the two hormones on the gastrointestinal localization of 99mTc. Pentagastrin produced accelerated uptake of the radionuclide in both the stomach and the ectopic gastric mucosa but resulted in early visualization of the duodenum and a "washout" effect on the radioisotope within the Meckel's diverticulum. Glucagon provided prolonged retention of the radionuclide in the stomach and ectopic mucosa and prevented duodenal visualization. A combination of both hormones produced increased activity in the stomach and experimental Meckel's and decreased duodenal filling. This enhanced target to background contrast and provided improved visualization of the ectopic gastric mucosa.

Animals↗
PubMed1980

Gastroschisis update.

Sixty-four infants with gastroschisis have been managed in the 9-yr period, 1970-1979, with four postoperative deaths. The silo technique has been the standard method of management in this series, permitting initial expansion of the abdominal cavity without increased abdominal pressure and respiratory embarassment. Removal of the silo and complete closure of the abdominal wall deficit were possible 5-12 days later. A high proportion of the infants were below 2500 g in weight at birth (61%); and although 3 of the 4 postoperative deaths occurred in the low birth weight group, this did not appear to be a factor in mortality. Associated anomalies occurred in 25 of the 64, but only the coincident intestinal atresias (6) were of major significance. These additional anomalies were not responsible for deaths. Two deaths occurred from problems dating from birth, one from aspiration and the second from sepsis. The other two resulted from postoperative complications resulting in infarction of the midgut. Both were caused in part by failure to adequately enlarge the abdominal wall defect at the time of the initial procedure. Other postoperative complications were relatively few. Although all required intravenous nutritional support, the long term results in terms of growth and development and of intestinal function were quite satisfactory.

Abdominal Muscles↗
PubMed1980

Characters of irreducible Harish-Chandra modules and Goldie ranks of their annihilators.

Assume that G(C) is a simply connected complex semi-simple Lie group with Lie algebra [unk]. Let G subset G(C) be a real form, H subset G be a maximally split Cartan subgroup with Lie algebra [unk](0), [unk] = [unk](0) [unk] C, and P subset, dbl equals [unk](*) be the weight lattice. If X is an irreducible Harish-Chandra module with infinitesimal character lambda in [unk](*), one can associate to X a family {theta(mu): mu in lambda + P} of Z-linear combinations of distribution characters of G, so that theta(lambda) = X. theta(mu) is irreducible when mu lies in C(lambda), a certain positive "Weyl" chamber containing lambda. In this case let Ann theta(mu) be its annihilator in U([unk]) and set p(mu) = Goldie rank of U([unk])/ Ann theta(mu). Let d = Gelfand-Kirillov dimension of X. For most x in [unk](0) if exp tx is regular for small t > 0 then (i) c(mu) = lim(t-->0(+) )t(d) theta(mu) (exp tx) exists for all mu in lambda + P; (ii) c(mu) extends to a homogeneous Weyl group harmonic polynomial on [unk](*) of degree (1/2)(dim G - dim H) - d; (iii) up to a constant, c = the polynomial extending p to [unk](*). c is said to be the character polynomial of Ann X.

Journal Article↗
PubMed1979

Adrenal cortical carcinoma: a clinical and pathologic study of 49 cases.

The clinical and pathologic features of 49 patients with adrenal cortical carcinoma are presented. The series included 26 men and 23 women with a mean age of 34 years. The average duration of symptoms prior to diagnosis was 6.6 months. Eighteen patients (37%) presented with recognizable endocrine syndromes secondary to excess tumor steroid production. Surgical excision was the only mode of therapy to offer any opportunity for prolonged survival. Nine of the 21 patients (43%) with a completely resectable tumor were alive with no evidence of disease an average of 7.2 years postoperatively. Death due to metastatic tumor occurred in 36 of the 49 patients (73%) an average of 8.7 months following diagnosis. Chemotherapy had no apparent effect on outcome while radiotherapy produced an objective palliative response in 50% of treated patients. The average size and weight of the tumors were 12.4 cm and 875.6 g, respectively. The difficulty of precise pathologic classification of certain large adrenal tumors is discussed and the importance of histopathologic features relative to gross morphologic findings is emphasized.

Adolescent↗
PubMed1979

Metabolism and defluorination of fluoroacetate in the brush-tailed possum (Trichosurus vulpecula).

The brush-tailed possum (T. vulpecula) from Western Australia was found to be nearly 150 times more resistant to fluoroacetate intoxication in vivo than the same species from South Australia. Acetone powder preparations from the liver of animals from both populations showed similar abilities to convert fluoroacetate into fluorocitrate. Aconitate hydratase activity in liver preparations from both Western Australian and South Australian animals was similarly and competitively inhibited by fluorocitrate. Both animals were capable of defluorinating fluoroacetate at similar rates by a glutathione-dependent enzymic mechanism resulting in the formation of free fluoride ion and S-carboxymethylcysteine. Glutathione was also capable of partial protection against the toxic effects of fluoroacetate in vitro by a further unelucidated mechanism.

Aconitate Hydratase↗