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Biomedical subjects

E H Smith

Publications and source records attributed to E H Smith.

At least 55 records · Page 3Linked to original sources
PubMed1979

Ultrasonic appearance of the falciform ligament.

In transverse liver scans an echogenic focus was commonly encountered at the junction of the right and left hepatic lobes. This finding was variable in prominence, but could be identified in 22 of 25 patients with otherwise normal livers in whom it was specifically sought. Correlation of ultrasound and CT examinations indicate that these echoes represent the falciform ligament. This normal anatomic structure can be differentiated from an intrahepatic mass by attention to its consistent location and alteration of its configuration by experimenting with the transducer axis during the examination.

Humans↗
PubMed1979

Lung metastases in cervical and endometrial carcinoma.

Carcinoma of the cervix or endometrium was evaluated in 1,021 patients at the Joint Center for Radiation Therapy, Boston, between July 1968 and December 1977. The patients were retrospectively evaluated for the presence of lung metastases, appearing initially or during their disease course. On chest radiography, 42 patients were found to have metastases. Lung metastases were seen in 5.1% of patients with carcinoma of the cervix and in 3.6% of patients with carcinoma of the endometrium. Median time from initial disease staging to detection of lung metastases was 12 months. Once pulmonary spread was discovered, 80% of patients expired within 1 year. Lung nodules varied greatly in size. In 11 patients they were solitary; five patients had pleural effusions; three had mediastinal or hilar adenopathy; and none had excavation.

Adult↗
PubMed1978

Investigation of the mechanism of the methylmalonyl-CoA mutase reaction with the substrate analogue: ethylmalonyl-CoA.

1. Ethylmalonyl-CoA was found to be a substrate for methylmalonyl-CoA mutase from Propionibacterium shermanii, the product being mainly (2R)-methylsuccinyl-CoA along with some (2S)-diastereoisomer. 2. The relevant 1H-nuclear magnetic resonance signals of methylsuccinic acid and of its dimethyl ester were assigned to the diastereotopic methylene hydrogens using sterospecifically dideuterated specimens of known configuration. 3. [2(-2)H1]Ethylmalonyl-CoA was converted by methylmalonyl-CoA mutase in 2H2O mainly to (2R, 3S)-[3(-2)H1]methylsuccinyl-CoA. No dideuterated product was observed. 4. Starting from (1R)-[1(-2)H1]-ethathanol, (1S)-[1(-2)H1]ethanol and [2H6] ethanol the following deuterated specimens of ethylmalonic acid were synthesised and characterised: (3S)-[3(-2)H1], (3R)-[3(-2)H1] and [3(-2)H2, 4(-2)H3], respectively. 5. Conversion of (3S)-[3(-2)H1]-ethylmalonyl-CoA (70% 2H1 and 2% 2H2 species) on the mutase in water afforded mainly (2R)-[2(-2)H1]methylsuccinyl-CoA along with some (2S)-diastereoisomer. No deuterium loss was observed. 6. Methylmalonyl-CoA mutase converted (3R)-[3(-2)H1]ethylmalonyl-CoA (81% 2H1 and 2% 2H2 species) to the following methylsuccinyl-CoA species: 33% [3(-2)H1], the deuterium being in the threo position with respect to the methyl group; 21% [2(-2)H1]; 46% unlabelled. The ratio of the species with (2R) and (2S) configuration was about 60:40. 7. Reaction of [3(-2)H2, 4(-2)H3]ethylmalonyl-CoA (94.5% [2H5] species) with the mutase gave the following labelled methylsuccinyl-CoA species:53.4% [methyl-2H3, 2(-2)H1, 3(-2)H1], the 3-deuterium being in the threo position with respect to the methyl group; 37.6% [methyl-2H3, 2(-2)H1]; 5% [methyl(-2)H3, 2(-2)H1, 2(-2)H1, 3(-2)H1] the 3-deuterium being in erythro position with respect to the methyl group; 4% [methyl(-2)H3, 3(-2)H1]. The ratio of the species with (2R) and (2S) configuration was about 70:30. 8. Implications of these findings for the mechanism of the rearrangements catalysed by coenzyme B12 are discussed.

Acyl Coenzyme A↗
PubMed1978

Intra-arterial radionuclide infusion: a new technique to assess chemotherapy perfusion patterns.

A mechanical infusion pump was used to introduce 99mTc-sulfur colloid at a rate of 1 ml/minute into the hepatic arteries of six patients. The radiotracer distribution patterns were compared to those obtained with "bolus" radionuclide angiography and those seen with standard contrast angiography. In all cases, the slow flow rate radionuclide studies evidenced dramatic differences from the patterns obtained with rapid flow rate injections. The results indicate that standard, rapid-injection contrast techniques may not produce the most reliable information regarding potential flow distribution. It is concluded that radiotracers introduced at flow rates approximating those attained with infusion pumps will offer the best estimates of both initial catheter placement and subsequent patterns of hepatic distribution of chemotherapeutic agents.

Adult↗
PubMed1977

The relationship of computed tomography and ultrasonography in diagnosis of abdominal disease.

A detailed comparison of computed tomography and ultrasonography of the abdomen is presented from a theoretical point of view. The advantages and limitations of both modalities are discussed in terms of scan content, resolution, plane of interrogation, dynamic imaging, examination time, imaging problems, automation, contrast administration, puncture guidance, examination availability, hazards, personnel and space requirements, and cost. Analysis of these factors leads the authors to conclude that ultrasound should be the procedure of choice for sectional imaging of the abdomen. Computed tomography should be reserved for those situations in which the ultrasound examination is not diagnostic (i.e., skeletal system, lungs, mediastinum).

Abdomen↗
PubMed1977

The ultrasonic demonstration of gastric lesions.

Fifteen cases of circumferential gastric antral disease identified by upper gastrointestinal (GI) series over a 12-month period were studied by a gray-scale ultrasound. In 93 per cent of the patients studied, a characteristic ovoid anechoic area containing a dense central collection of echoes was identified. The abnormality was located in the midline or slightly to either side, just dorsal to the inferior margin of the liver on longitudinal sections. The lesions studied included primary and secondary malignancy, lymphoma, corrosive gastritis, and granulomatous disease of childhood. In each instance a barium study of the stomach confirmed the location of the lesion. A prospective study of 50 normal individuals revealed one patient in whom the characteristic appearance was found at ultrasound and who subsequently had a normal upper GI series. Thus, although the ultrasound appearance of antral thickening may rarely be found in normal individuals, this characteristic appearance should strongly suggest gastric pathology, necessitating an upper GI series.

Adolescent↗
PubMed1977

Ultrasound in renal transplantation.

Because of important differences in prognosis and treatment, prompt and accurate diagnosis of fever, decreasing function, and pain and tenderness around a renal allograft is crucial for differentiation between acute rejection and other post-operative conditions which may give a similar picture. Ultrasound examinations within 24 hours have been performed on all transplant recipients exhibiting symtoms compatible on all transplant recipients exhibiting symptoms compatible with an episode of acute rejection between September 1973 and June 1976 at the Peter Bent Brigham Hospital. The patients were separated into four groups dependent upon diagnosis by ultrasound; Group I(73 patients); allograft enlargment consistent with acute rejection; Group II (14 patients); dilitation of the collecting system; Group III (14 patients); perinephric fluid collections; Group IV (6 patients); miscellaneous conditions. The accuracy of the ultrasound technique was compared within each group to the results from intravenous pyelography, retrograde pyelography, serial renograms, kidney biopsy and/or surgical exploration. This convenient, non-invasive and reproducible method has been extremely effective in the differential diagnosis of rejection in clinical transplantation.

Adult↗
PubMed1977

Ultrasonic evaluation of the obstructed duplex kidney.

The problem of a duplex collecting system associated with an obstructed ectopic ureter or ureterocele is common in pediatric urology. Four such patients were studied by gray scale ultrasound which was useful in demonstrating the dilated upper pole collecting system as well as an ectopic ureter and a ureterocele. Although the diagnosis of a nonfunctioning upper pole unit in a duplex kidney is usually suggested by the urogram, ultrasound provides a noninvasive means of confirmation which is independant of function. Further, ultrasound-guided puncture with antegrade pyelography demonstrates the course of the ectopic ureter, thus providing a more complete preoperative evaluation.

Adult↗
PubMed1977

The mechanism of urinary concentration in nephrogenic diabetes insipidus.

The authors have evaluated urinary adenosine 3',5'-monophosphate (cyclic AMP) excretion and renal function during Pitressin administration, hypertonic saline administration, and water deprivation in two siblings with vasopressin-resistant diabetes insipidus and in normal control subjects. After vasopressin administration normal subjects experienced a 2-fold rise in urinary cyclic AMP excretion from 3.2 +/- 0.7 to 5.6 +/- 1.3 nmol/min (P less than 0.001) whereas cyclic AMP excretion was unchanged in both patients (patient AC 4.4 +/- 0.9 to 4.3 +/- 2.1; patient TC 2.2 +/- 0.9 to 2.6 +/- 0.9 nmol/min) with nephrogenic diabetes insipidus (NDI). Urinary cyclic AMP excretion was measured during infusion of 2.5% saline, after vasopressim administration, and after water deprivation. Cyclic AMP excretion was not different from control values in the NDI patients during any of the experimental conditions. Furthermore, there was no difference in cyclic AMP excretion when periods of dilute urine excretion (patient AC 4.5 +/- 1.1; patient TC 2.1 +/- 0.8 nmol/min) were compared with periods when urine concentration was greater than that of plasma (AC 3.5 +/- 1.3; TC 1.8 +/- 0.9 nmol/min). Both subjects responded to parathyroid hormone infusion with a 2-fold increase in urinary cyclic AMP excretion. Excretion of concentrated urine was paralleled by a marked decrease in urine flow to less than 1 ml/min/m2. During periods of hypotonic urine excretion (Uosm/Posm less than 1.0) average glomerular filtration rate (GFR) in patient AC was 67.0 +/- 3.0 ml/minm2 whereas in patient TC it was 70.1 +/- 8.1 ml/min/m2. When each patient was excreting a hypertonic urine (Uosm/Posm greater than 1.0) after fluid deprivation their GFR had decreased significantly (P = 0.001) to 31.6 +/- 8.9 and 33.3 +/- 10.3 ml/min/m2, respectively. Ability of these two subjects with NDI to concentrate their urine to Uosm/Posm greater than 1.0 in the absence of an increase in urinary cyclic AMP but associated with a decrease in GFR to 50% normal indicates that urinary concentration was effected by a reduction in GFR rather than a partial response to antidiuretic hormone (ADH). Their ability to concentrate their urine during periods of modest volume depletion would protect them from progressing to more severe stages of dehydration and result in the relatively benign course of their disease. It is feasible that in patients previously reported to have had clinically "partial" NDI this mechanism may have been operative.

Adolescent↗
PubMed1976

Proteinuria and hematuria in schoolchildren: epidemiology and early natural history.

Over the past several decades screening for disease in large asymptomatic populations has increased, culminating most recently with a federal mandate for early, periodic screening, diagnosis and treatment of all children from low-income families. The present study of five consecutive examinations in over 12,000 schoolchildren shows the cumulative occurrence of proteinuria and hematuria to be surprisingly high (greater than 6%). Comparison of this large number of children with the few individuals in whom death occurs from chronic renal disease annually (less than 0.03%) suggests that the vast majority of these children with urinary abnormalities have either no renal disease or at most a self-limited condition. Observation of 512 children with proteinuria and 78 with hematuria for one to five years after initial detection and referral to their physician or clinic provides a measure of both contemporary management and early natural history. These observations suggest that there is a need to question the overall effectiveness of urinary screening and that early inclusion of roentgenographic and urologic investigations in management seems unwarranted. Rather, these children should be followed for long periods of time. Additional investigations are indicated when worsening of the abnormal findings or other evidence of renal or systemic disease occurs. If routine urinary screening is performed, it should be as one aspect of a multiphasic program by the primary physician so that it can be coupled with a clearly defined plan for follow-up and management of subjects with abnormal findings.

Age Factors↗
PubMed1976

Evaluation of renal transplants with ultrasound.

Ultrasound scanning is useful in evaluating renal transplants: it is atraumatic, independent of renal function, and well suited for analyzing such common complications as lymphocele, abscess, hydronephrosis, and hematoma. When there is uncertainty as to the nature of a paranephric mass, ultrasonically guided percutaneous aspiration is definitive. Ultrasound can also detect the acute increase in renal volume associated with rejection and may prove to be a valuable adjunct in the early diagnosis of this problem.

Abscess↗
PubMed1975

Percutaneous aspiration biopsy of the pancreas under ultrasonic guidance.

Fine-needle aspiration biopsy for cytologic diagnosis was performed on seven patients suspected of having pancreatic tumors. A 23-gauge biopsy needle was accurately placed in the suspicious lesion under ultrasonic guidance. Six patients had tumors; of these, five had a definite cytologic diagnosis, and the sixth was suspicious of tumor. There was no morbidity associated with the procedure in these patients. Although fine-needle biopsy is not expected to prolong life in patients with pancreatic tumors, it does eliminate the need for more complicated, expensive, uncomfortable and hazardous diagnostic procedures. In many cases exploratory surgery may be obviated.

Biopsy, Needle↗
PubMed1975

The usefulness of ultrasound in the evaluation of renal masses in adults.

The efficacy of ultrasonography in the diagnosis of renal masses in our own series and in the recent literature has been reviewed. Ultrasonography in combination with cyst puncture approaches 100 per cent accuracy in the diagnosis of lesions more than 3 cm. in diameter that can be adequately delineated. Complications appear to be minimal.

Adenocarcinoma↗