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Biomedical subjects

E L Jones

Publications and source records attributed to E L Jones.

At least 73 records · Page 4Linked to original sources
PubMed1994

Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts.

This study examines the long-term frequency of reoperative coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) after CABG. The source of data was the clinical database at Emory University Hospitals. The population comprised 3,480 patients undergoing a first CABG between 1978 and 1981. Event-free survival was determined using the Kaplan-Meier method and determinants of survival with the Cox proportional-hazards model. The in-hospital mortality was 1.0% and 5-, 10- and 12-year survival was 91, 78 and 70%. The 5-, 10- and 12-year freedom from reoperative CABG was 98, 88 and 80%. The 5-, 10- and 12-year freedom from PTCA was 98, 91 and 85%. The 5-, 10- and 12-year freedom from either CABG or PTCA was 96, 81 and 69%. Younger patients had much higher incidences of repeat procedures. The yearly incidence of repeat procedures accelerated over time. These data reveal the ultimately palliative nature of revascularization for coronary artery disease.

Aged↗
PubMed1994

Interaction of age and coronary disease after valve replacement: implications for valve selection.

The interaction of patient age and the presence of coronary artery disease (CAD) and its influence on survival were examined in 3,644 patients undergoing either aortic (AVR) or mitral (MVR) valve replacement with or without coronary artery bypass grafting (CABG) between 1974 and 1991. Emergency procedures were performed much more frequently in those undergoing MVR and CABG than in those undergoing AVR and CABG (18.8% and 6.7%, respectively). The adverse effect of CAD on median survival for patients of all ages undergoing either AVR or MVR was statistically significant (AVR without CAD 11.8 versus 8.7 years with CAD; MVR without CAD 12.7 versus 7.3 years with CAD; p < 0.0001). Survival in patients younger than 70 years without CABG who underwent either AVR or MVR was quite good (< 60 years: AVR, > 14 years; MVR, 15.4 years; 60 to 69 years: AVR, 10.4 years; MVR, 11.4 years). The most profound effect of CAD on patient survival after valve replacement was observed in patients 60 to 69 years of age who underwent MVR, in whom the median survival without CABG was 11.4 years versus 5.5 years with CABG (p < 0.0001). An emergency operative status was associated with a reduced early and late survival for those patients undergoing MVR, particularly those with CAD. By relating the Cox proportional hazard models for valve survival to patient survival, we found that, in those patients 70 years and older with and without CAD who underwent either AVR or MVR, the median patient survival was reduced sufficiently (5.5 versus 8.1 years) to justify use of a bioprosthetic valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1994

Comparative study of calcipotriene (MC 903) ointment and fluocinonide ointment in the treatment of psoriasis.

BACKGROUND: The topical vitamin D analogue calcipotriene has been reported to be an effective treatment for patients with psoriasis. Comparative studies with topical steroids are informative in judging this new therapy. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of calcipotriene ointment 0.005% versus fluocinonide ointment 0.05% in the treatment of plaque psoriasis. METHODS: This study was a randomized, double-blind, parallel-group, active-controlled trial in adults who had at least mild overall disease severity and plaque elevation of at least moderate severity. Treatments were applied twice daily for 6 weeks, and subjects were evaluated at weeks 0, 2, 4, and 6. Subjects were graded on a 9-point scale (0 to 8) for scaling, erythema, plaque elevation, and for overall disease severity. A physician's global assessment of improvement/worsening was performed at every visit. RESULTS: A total of 114 subjects were enrolled at six study sites. Ninety-nine subjects completed the trial. Mean scores for signs of scaling and plaque elevation in calcipotriene-treated subjects were significantly lower by week 2 than in the fluocinonide-treated subjects. These scores continued to be significantly lower than fluocinonide through week 6 (p < 0.05). Mean scores for erythema in calcipotriene-treated subjects were significantly lower than those in fluocinonide-treated subjects at weeks 4 and 6 (p < 0.05). Both the physician's global assessment and overall disease severity showed statistically significant treatment differences in favor of calcipotriene at week 4 (p < 0.05). This superior efficacy continued through week 6. Treatment-related adverse events were observed in 12 calcipotriene-treated subjects and 5 fluocinonide-treated subjects; all were considered minor. CONCLUSION: Calcipotriene was superior to fluocinonide in the treatment of plaque psoriasis.

Adult↗
PubMed1994

Aortic valve replacement in the young.

The attractiveness of the aortic allograft in any form, whether it be free style or root, is the high 10-year freedom from thromboembolism, absence of requirement for anticoagulants, use in active infections, excellent hemodynamics, and freedom from reoperation. The 10-year freedom from all valve related complications has been reported to be around 92% versus only 75% for the porcine bioprosthetic valve. Gradients across the allograft aortic valve are comparable to that of the St. Jude valve (St. Jude Medical, St. Paul, MN, USA) with valve areas approaching 2 cm2 in the extremely large homograft. Between November 1986 and September 1993, the author used the aortic allograft as a freehand procedure in 51 patients and for root replacement in 22 patients. Stimulus for use of limited root replacement with the allograft in aortic valve replacement has occurred because of the unpredictability of the freehand operation with regard to valve insufficiency. This has been done in spite of the Ross modification of retaining the noncoronary sinus. Evaluation of freehand allograft function by echo analysis has demonstrated an unacceptable incidence of insufficiency not found when a small segment of the allograft root is used. The native coronary arteries, however, must be transposed to the donor root, which of itself has the potential of introducing new problems not seen with other valve substitutes. Complications with the freehand allograft have consisted of explanation in eight patients, four early and four late. Six of the early and late explanations have been for insufficiency. Techniques of valve and valve root implantation will be presented in detail.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1994

Mitral valve replacement: indications, choice of valve prosthesis, results, and long-term morbidity of porcine and mechanical valves.

Indications for specific valve types, whether they be mechanical or bioprosthetic, have been rigorously defined in recent years. Candidates for bioprosthetic valves would be: older patients, patients who are noncompliant or have contraindications to anticoagulation, patients in normal sinus rhythm, and young females desirous of future pregnancy. Recent data suggest that patient age and presence of coronary artery disease may significantly alter the indications for mechanical or tissue valves. There is mounting evidence that patients without coronary disease in their 60s and 70s who require valve replacement are better served with a mechanical prosthesis. At Emory University Hospitals, 440 patients operated upon between 1974 and 1981 were followed for a mean period of 8.3 years. No patients having coronary artery disease were included in the cohort. Survival at 10 years was 64%. The actuarial freedom from all major valve related complications at the end of 10 years is compared to other series. Data suggests that patient survival for mitral valve replacement is affected by the etiology of the valve disease necessitating the operation. The best survival occurs in patients in whom the mitral valve replacement is for myxoid degeneration and may explain the excellent survival to be expected for mitral valve repair and concomitant coronary bypass. The most significant factor increasing morbidity and mortality in patients with mitral valve replacement and coronary artery disease is high end-diastolic pressure associated with significant depression of regional wall motion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

ChlVPP/PABlOE and radiotherapy in advanced Hodgkin's disease. The Central Lymphoma Group.

PURPOSE: The United Kingdom Central Lymphoma Group (CLG) has modified mechlorethamine, vincristine, procarbazine, and prednisone/doxorubicin, bleomycin, vinblastine, and dacarbazine (MOPP/ABVD) by substituting mechlorethamine with chlorambucil and dacarbazine with etoposide in the treatment of patients with advanced Hodgkin's disease (HD). Prednisolone is included in the bleomycin-containing combination, and the vinca alkaloids have been switched to balance the myelotoxicity of the two component regimens. PATIENTS AND METHODS: The resulting ChlVPP/PABlOE regimen is as follows: on days 1 to 14, chlorambucil 6 mg/m2 orally, procarbazine 100 mg/m2 orally, and prednisolone 30 mg/m2 orally; on days 1 and 8, vinblastine 6 mg/m2 intravenously (i.v.); on day 29, doxorubicin 40 mg/m2 i.v.; on days 29 and 36, vincristine 1.4 mg/m2 (maximum, 2 mg) i.v., and bleomycin 10 mg/m2 i.v.; on days 30, 31, and 32, etoposide 200 mg/m2/d orally; on days 29 to 43, inclusive, prednisolone, 30 mg/m2 orally. The second full cycle restarts on day 50. Treatment continues to maximum response plus two full cycles, but with a minimum of three full cycles. Radiotherapy is administered, after chemotherapy, to sites of previously bulky disease. Since 1983, 216 patients with previously untreated, advanced Hodgkin's disease (HD) have entered this study. RESULTS: The complete remission (CR) rate after chemotherapy was 73% (95% confidence interval [CI], 67% to 79%), and after additional radiotherapy was 85% (95% CI, 80% to 90%). The failure-free survival (FFS) rate at 5 years was 68% (95% CI, 61% to 74%), and the overall actuarial survival at 5 years was 78% (95% CI, 72% to 84%). The CR rate in patients in the poorer prognostic categories was high: 81% in patients with albumin levels less than 37 g/L, 79% in patients older than 40 years of age, 84% in stages IIIB plus i.v. disease, and 79% in patients presenting with B symptoms. As expected, nausea and vomiting were not major problems, although infection, often in the context of myelosuppression, complicated almost half the cases, and 29% of patients required admission at some stage for treatment of infection. CONCLUSION: In this multicenter study, ChlVPP/PABlOE produced results comparable to those reported for MOPP/ABVD, but with less nausea and vomiting. Treatment duration was shorter than in the original MOPP/ABVD regimen, and than that used in the Cancer and Leukemia Group B (CALGB) trial. It will now be compared with PABlOE alone.

Adult↗
PubMed1994

Latent Epstein-Barr virus infection in cottontop tamarins. A possible model for Epstein-Barr virus infection in humans.

The association of Epstein-Barr virus (EBV) with a growing number of human malignancies underlines the importance of efforts aimed at preventing the infection with this potential carcinogen and of establishing animal models for human virus-associated tumors. Cottontop tamarins have been used in EBV vaccine studies because virus infection regularly induces lymphomas similar to those seen in human immunocompromised individuals. In recent years, several vaccines based on the gp340/220 envelope protein of EBV have been developed and shown to prevent the development of EBV-associated lymphomas in this model. Using in situ hybridization and immunohistology, we have characterized EBV infection in one nonimmunized and three immunized animals after challenge with a standard tumorigenic dose of EBV. In the nonimmunized animal, EBV-infected lymphoid cells were detected in numerous tissues showing no obvious lymphoma infiltration. Surprisingly, variable numbers of virus-carrying cells were also found in all three immunized animals that were protected against the development of virus-associated lymphoma. This observation demonstrates that vaccination does not induce sterilizing immunity against EBV infection in this model. Double labeling suggested a B cell phenotype of the majority of these cells. EBV infection of nonlymphoid cells was not observed. Analysis of viral gene expression in immunized animals suggested a restricted form of virus latency different from that seen in EBV-driven lymphomas in nonimmunized cottontop tamarins. These results raise the possibility that immunized cottontop tamarins protected against the development of EBV-driven lymphoma or animals exposed to a sublymphomagenic dose of virus may serve as a model for EBV infection in humans.

Animals↗
PubMed1993

Coronary surgery and coronary angioplasty in patients with two-vessel coronary artery disease.

There is uncertainty regarding the selection between coronary artery surgery and angioplasty in many patients with coronary artery disease, especially in those with 2-vessel disease. Whereas randomized trials will provide the best possible and most detailed data comparing therapy in these patients, clinical data bases may be used to provide a current perspective. The purpose of this study was to compare the long-term outcome of patients with 2-vessel coronary artery disease undergoing coronary surgery or angioplasty at Emory University hospitals in the years 1984 and 1985. Data on all patients with 2-vessel disease diagnosed at Emory University who underwent elective angioplasty or coronary surgery in the years 1984 and 1985 were compared. Categoric variables were analyzed by chi-square and continuous variables by unpaired t test. Survival was determined by the Kaplan-Meier method and differences in survival by the Mantel-Cox method. Determinants of survival were determined by Cox model analysis. There were 415 angioplasty patients and 454 surgical patients. Surgical patients were older and had more frequent systemic hypertension, diabetes mellitus, prior myocardial infarction, severe angina and congestive failure, and more significant narrowing in the left anterior descending coronary artery, totally occluded vessels and left ventricular dysfunction than did angioplasty patients. Complete revascularization was achieved more often in surgical patients. There was no difference in Q-wave myocardial infarction in the hospital. No angioplasty patient died compared with 1.1% of surgical patients (p = 0.03). Whereas 5-year survival was 93% in angioplasty patients and 89% in surgical patients (p = 0.11), there was no difference in risk-adjusted survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Overexpression of p53 in Hodgkin's disease: lack of correlation with Epstein-Barr virus infection.

Recent work has shown that p53 gene mutations are frequently found in Epstein-Barr virus (EBV)-positive and EBV-negative cases of Burkitt's lymphoma but not in EBV-associated undifferentiated nasopharyngeal carcinomas (NPCs). Similar viral gene expression patterns are observed in undifferentiated NPCs and in EBV-positive cases of Hodgkin's disease (HD), suggesting that the contribution of the virus to the pathogenesis of these malignancies may also be similar. We have analysed 116 cases of HD for EBV association and for immunohistologically detectable overexpression of p53. p53 overexpression was detected in the tumour cell population of 37 (32 per cent) of the cases. Fifteen cases showed p53-specific labelling of more than 40 per cent of tumour cells; in six of these, virtually all tumour cells were stained. In eight cases, between 5 and 40 per cent of tumour cells were labelled, and in another 14 cases, less than 5 per cent of tumour cells expressed detectable amounts of p53. EBV-positive HD cases were found in all groups with different levels of p53 overexpression as well as amongst p53-negative cases. While a more detailed analysis of the p53 gene in HD is required, these data show that overexpression of p53 in HD is heterogeneous and that there is no simple correlation between EBV infection and p53 overexpression.

Gene Expression↗
PubMed1993

P53 overexpression and Epstein-Barr virus infection in undifferentiated and squamous cell nasopharyngeal carcinomas.

We have analysed 22 nasopharyngeal carcinomas (NPCs) for expression of the small nuclear Epstein-Barr virus (EBV)-encoded RNAs (EBERs) and for immunohistologically detectable overexpression of p53. In situ hybridization demonstrated expression of the EBERs in 13 undifferentiated NPCs while nine squamous cell NPCs were EBER-negative. These results therefore confirm our previous DNA-DNA in situ hybridization studies and demonstrate that in the nasopharynx EBV is exclusively associated with undifferentiated but not with squamous cell carcinomas. p53 overexpression was demonstrated by immunohistology in 5 of 9 squamous cell NPCs and in 9 of 13 undifferentiated NPCs. Thus, there appears to be no correlation of p53 overexpression with EBV infection. These results are unexpected in the light of previous studies demonstrating that the p53 gene in primary undifferentiated NPC is consistently in the wild-type configuration. By contrast, analyses of squamous cell carcinomas of the head and neck have demonstrated that p53 overexpression in these cases is the result of p53 gene mutation. Whilst more detailed genetic analysis is required, our results suggest that mechanisms other than mutation of the p53 gene may be responsible for the stabilization of the protein in cases of undifferentiated NPC. It is tempting to speculate that an EBV-encoded protein may be involved.

Carcinoma↗
PubMed1993

Bilateral mammary artery grafting: avoidance of complications with extended use.

This study was undertaken to more clearly define the operative risks and appropriate strategies for the selection of patients who might be candidates for bilateral internal mammary artery grafting. A review of the 674 patients who underwent this procedure was performed over a 10-year period from January 1982 through 1991. These patients represented 5% of the 12,824 patients who underwent bypass grafting during this period. The mean patient age was 54 +/- 9.4 years, and 92% of the patient were male. Diabetes was present in 17.5%, with 24% of this group insulin dependent. The ejection fraction was less than 0.50 in 26.7% and 14% had had previous bypass procedures. Hospital mortality was 1.9% (n = 13). Hospital morbidity included wound infection in 3.6%, reoperation for bleeding in 2.1%, and stroke in 1.6%. Postoperative intraaortic balloon pump support was necessary in 2.8%. Univariate and multivariate analysis revealed that advanced age, an emergent operative status, and the number of diseased vessels (especially left main obstruction) were predictors of hospital death. Except for wound infection (9.3% versus 2.5%) and length of hospital stay (10.8 +/- 11.8 days versus 8.8 +/- 7.6 days), the complications in diabetics were similar to those in patients without diabetes, respectively. At 5 years, freedom from death, death or infarctions, and death, myocardial infarction, or coronary reoperation was 90%, 70%, and 62%, respectively. The only significant multivariate correlates of long-term survival were diabetes and reoperative surgery.

Aged↗
PubMed1993

Coronary revascularization in a patient with porcelain aorta and calcified great vessels.

Calcification of the aorta and great vessels in coronary artery bypass patients remains a challenging dilemma for the surgeon regarding bypass technique, choice of conduit, and available location of proximal anastomotic sites. Internal mammary artery flow may be inadequate, and the risk of systemic emboli from a diseased aorta is substantial. We report a case of a 69-year-old diabetic patient with a porcelain aorta extending into the aortic arch and great vessels who was revascularized using an altered anastomotic technique of right coronary artery endarterectomy for proximal anastomosis of vein grafts. Intraoperative echocardiographic evaluation of the aorta and arch was beneficial in determining extent of calcification.

Aged↗
PubMed1993

Epstein-Barr virus and carcinomas: rare association of the virus with gastric adenocarcinomas.

We have analysed 174 gastric carcinomas from the United Kingdom and from Japan for the presence of Epstein-Barr virus (EBV) using in situ hybridisation for the small EBV-encoded nuclear RNAs (EBERs). EBV was detected in the tumour cells in all of six undifferentiated gastric carcinomas with prominent lymphoid stroma (undifferentiated carcinomas of nasopharyngeal type, UCNT) but only in three of the remaining 168 typical gastric adenocarcinomas (1.8%). No differences were observed between the British and the Japanese cases. One case with an EBV-positive UCNT showed adjacent areas of EBV-negative typical adenocarcinoma. It is uncertain whether these patterns represent two independent carcinomas or whether they are the result of heterogeneous EBV infection in a single tumour. In the remaining EBV-positive carcinomas, viral transcripts were detected in virtually all tumour cells, indicating that EBV infection must have taken place early in the neoplastic process and suggesting that the virus is likely to be of pathogenetic significance for the virus-associated tumours. Immunohistology demonstrated absence of detectable levels of the EBV-encoded latent membrane protein, LMP1, and nuclear antigen, EBNA2. The BZLF1 protein which induces the switch from latent to lytic infection was demonstrated in a small proportion of the tumour cells in three cases. The close association of EBV with undifferentiated gastric carcinomas compared to the variable association with gastric adenocarcinomas suggests fundamentally different roles for the virus in the aetiology of these two malignancies.

Adenocarcinoma↗
PubMed1993

Changing clinical characteristics of coronary surgery patients. Differences between men and women.

BACKGROUND: There is uncertainty as to the relative efficacy of coronary artery bypass graft surgery (CABG) in men and women. Differences between sexes may be of greater importance than heretofore because of increased frequency of risk factors for adverse outcome. It is the purpose of this study to examine the changing clinical characteristics of patients undergoing CABG and to determine the influence of these changes on the results of CABG in men and in women. METHODS AND RESULTS: The source of data was the clinical database at Emory University Hospitals. The population comprised 13,368 patients (2648 women, 10,720 men) who had cardiac catheterization followed by CABG between 1974 and 1991. The patients were divided into the time periods 1974 through 1979 (532 women, 2792 men), 1980 through 1983 (727 women, 3151 men), 1984 through 1987 (695 women, 2619 men), and 1988 through 1991 (694 women, 2158 men). Data were collected prospectively and entered into a computerized database. The women were older (63 +/- 10 versus 58 +/- 10 years, P < .0001) and more frequently had diabetes (26.0% versus 15.4%, P < .0001). The in-hospital mortality was 3.8% in women and 1.6% in men. The multivariate correlates of death were older age, emergent surgery, reduced ejection fraction, female sex, diabetes, and more severe distribution of coronary arterial narrowings. Each of these risk factors for death became more prevalent, such that the mortality in men increased from 1.0% in 1974 through 1979 to 2.7% in 1988 through 1991, whereas the mortality in women increased from 1.3% in 1974 through 1979 to 5.4% in 1988 through 1991. CONCLUSIONS: The population undergoing CABG has aged, with correlates of in-hospital death becoming more common. The higher mortality in women could only partially be explained by other clinical variables. In addition, the risk of death after CABG has increased in women more than in men because women have consistently been older, have more emergent surgery and diabetes, and in recent years more women undergoing CABG have three-vessel or left main disease.

Age Factors↗
PubMed1992

Development of a water-soluble, sulfated (1-->3)-beta-D-glucan biological response modifier derived from Saccharomyces cerevisiae.

This report describes a method for the solubilization of micro-particulate (1-->3)-beta-D-glucan. Insoluble glucan is dissolved in methyl sulfoxide and urea (8 M) and partially sulfated at 100 degrees. The resulting water-soluble product is called glucan sulfate. The conversion rate is 98%, and the preparation is endotoxin free as determined by the Limulus lysate procedure. Glucan sulfate is composed of 34.06% C, 6.15% H, 50.30% O, 5.69% S and 3.23% N, and has a repeating unit empirical formula of (C6H10O5)8.3 SO3NH4+.4 H2O, suggesting that, on the average, a sulfate group is substituted on every third glucose subunit along the polymer. Molecular weight averages, polydispersity, and intrinsic viscosity were determined by aqueous high-performance size-exclusion chromatography (HPSEC). Two polymer peaks were resolved. Peak 1 (Mw = 1.25 x 10(6) g/mol) represents < 1% of the total polymer mass. Peak 2 (Mw = 1.45 x 10(4) g/mol) comprises > 99% of polymers. 13C NMR spectroscopy confirmed the beta-(1-->3) interchain linkage. In solution, glucan sulfate polymers self-associate in a triple helix. Glucan sulfate stimulates murine bone marrow proliferation following intravenous administration. The ability to prepare a immunologically active, water-soluble (1-->3)-beta-D-glucan preparation will greatly enhance the clinical utility of this class of compounds.

Animals↗