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Biomedical subjects

E M Ward

Publications and source records attributed to E M Ward.

54 records · Page 3Linked to original sources
PubMed1993

Identification of soft tissue sarcoma deaths in cohorts exposed to dioxin and to chlorinated naphthalenes.

Identification of soft tissue sarcomas (STSs) in epidemiologic mortality studies is complicated by nosologic coding rules that require that STSs arising in a visceral organ must be coded in the International Classification of Diseases (ICD) category for that organ, rather than in the ICD category for malignant neoplasms of connective tissue. Moreover, prior studies have shown poor agreement between diagnoses recorded on death certificates compared with those in hospital records for these tumors. We reviewed deaths from STS among workers in a registry of 6,716 dioxin-exposed workers at the National Institute for Occupational Safety and Health (NIOSH) and in a NIOSH cohort mortality study of 10,240 workers exposed to chlorinated naphthalenes. We identified 19 subjects with STSs. Of these, 17 (89%) were identifiable by reading the entries on selected death certificates, and two (11%) were found only by reviewing medical records of cases coded to ICD categories likely to have contained STS. Of the 17 STSs identified from death certificates, only nine (53%) had been coded as underlying cause of death to the ICD category "malignant neoplasms of soft and connective tissue." Medical records were obtained for 14 of the 17 cases (82%), and in each case, the STS diagnosis was verified. Tissue blocks from tumors were available for review in nine of the 17 cases identified from death certificates, and the diagnosis of STS was verified in seven (78%). Nosologic rules reduce the sensitivity of cohort mortality studies to detect excesses of STS.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗
PubMed1993

Comparison of nasal pressure support ventilation with nasal intermittent positive pressure ventilation in patients with nocturnal hypoventilation.

Nasal intermittent positive pressure ventilation (NIPPV) provides effective ventilatory support in patients with nocturnal hypoventilation. Nasal pressure support ventilation (NPSV), which only provides ventilation in response to patient triggering, may also be effective, simpler, and cheaper, but has not been evaluated. NIPPV and NPSV were compared in 12 patients with nocturnal hypoventilation, requiring domiciliary ventilatory support. The patients were studied on three consecutive nights, in random order: a control night without ventilation and a night on each mode of ventilatory support using the bilevel positive airway pressure (BiPAP) ventilator. Both NIPPV and NPSV significantly increased mean arterial oxygen saturation (SaO2) compared to the control night (NIPPV mean increase 4.1%; 95% confidence interval (CI) 2.2 to 6.1, NPSV 4.4%; CI 2.1 to 6.6) with no significant difference between the two modes. The percentage of the study night spent below 90% SaO2 was significantly reduced by both ventilator modes compared to the control night (median reduction on NIPPV 37%; CI -54 to -10, reduction on NPSV 31%; CI -53 to -9, with no significant difference between NPSV and NIPPV. NPSV was as effective as NIPPV in patients with nocturnal hypoventilation, which suggests that these patients are able to trigger the ventilator adequately. The lower cost of NPSV will make it accessible to more patients with chronic lung disease.

Female↗
PubMed1992

Ischemic-type biliary complications after orthotopic liver transplantation.

Nonanastomotic biliary strictures that involve only the biliary tree of the graft occur after orthotopic liver transplantation in patients with hepatic artery thrombosis, chronic ductopenic rejection and ABO blood group incompatibility. This complication may also occur in the absence of these known risk factors. The major focus of our study was to evaluate the risk factors for nonanastomotic biliary stricturing of unknown cause after orthotopic liver transplantation. Results demonstrate that the development of biliary strictures is strongly associated with the duration of cold ischemic storage of allografts in both Euro-Collins solution and University of Wisconsin solution. Results also demonstrate that strictures are not associated with the type of biliary reconstruction, the primary liver disease, cytomegalovirus infection, allograft rejection or the presence of a positive lymphocytotoxic crossmatch. More recently, we have markedly reduced the occurrence of nonanastomotic biliary stricturing by decreasing the ischemia time of our allografts. Thus nonanastomotic biliary strictures appear to be the result of the ischemia/reperfusion-induced tissue injury associated with the harvest and implantation of allografts.

Adenosine↗
PubMed1992

Interactions of the beta carboline abecarnil with the high pressure neurological syndrome in a primate model.

The neurophysiological interactions between the high pressure neurological syndrome (HPNS) and a new beta carboline, abecarnil, were studied in the non-human primate Papio anubis. Abecarnil is a partial agonist at the benzodiazepine site on the GABA/benzodiazepine receptor. Six animals were exposed on two occasions to pressures of 91 ATA in an environment of helium and oxygen. One exposure was pretreated with a total dose of abecarnil 1.0 mg/kg, the other with an equivalent volume of vehicle. Treatment with abecarnil prevented the severe signs of HPNS occurring between 51 and 91 ATA. Onset pressures of the various signs were unaffected. Some signs, e.g. myoclonus, became more frequent when abecarnil was used. A residual protective effect of abecarnil was present 4 weeks after the dose was given, active at pressures less than 71 ATA. Changes with pressure in the EEG were recorded primarily from the frontal cortex, but were also present in the parietal and occipital areas of the left cortex. Amplitude and frequency spectra were calculated and changes with pressure in the four conventional wavebands, plus two others, analysed. The most striking change was the prevention by abecarnil of the pressure-induced 100% increase in alpha wave amplitude in the frontal region. It is concluded that modulation of GABA transmission is important in controlling the expression of HPNS.

Animals↗
PubMed1991

The effects of the competitive NMDA receptor antagonist CPP on the high pressure neurological syndrome in a primate model.

Neurophysiological interactions between the competitive N-methyl-D-aspartate (NMDA) preferring receptor antagonist, CPP (3-((+-)-2-carboxypiperazine-4-yl)-propyl-1-phosphonate) and the high pressure neurological syndrome (HPNS) have been investigated in the non-human primate Papio anubis. Eight animals were exposed on two occasions to environmental pressures of 81 atmospheres absolute (ATA) in a hyperbaric chamber, using helium and oxygen. One exposure followed pretreatment with CPP (either 5 or 10 mg/kg i.v. plus 5 mg/kg/hr infusion), the other a saline control. Pretreatment with CPP delayed moderate signs of face tremor and myoclonus and abolished severe signs of whole body tremor and seizure activity. By 81 ATA, scores representing severity of HPNS were significantly reduced by CPP to a mean score, reflecting a level of just mild to moderate limb tremoring (P less than 0.001). Changes in the EEG were observed in channels associated with the frontal, parietal and occipital regions of the left cortex. Amplitude and frequency spectra were calculated and changes with pressure in the 4 conventional wavebands were analysed. The most striking change was the complete prevention by CPP of the 100% increase in the amplitude of alpha waves at 81 ATA in the frontal region (P less than 0.001). It is concluded that NMDA transmission has a major role in the expression of HPNS.

Animals↗
PubMed1991

Persistent bile leak after liver transplantation: biloma drainage and endoscopic retrograde cholangiopancreatographic sphincterotomy.

Persistent bile leaks after liver transplantation were successfully treated in three patients with percutaneous or surgical drainage of bilomas and endoscopic retrograde ampullary sphincterotomy. In all three patients, biliary anastomoses were achieved by means of choledochocholedochostomies, with a T-tube stent in the anastomosis. The bile leaks led to subhepatic bilomas that had persistently high catheter outputs (greater than 200 mL per 24 hours) for longer than 1 month. Biloma drainage decreased shortly after sphincterotomy.

Ampulla of Vater↗
PubMed1990

Hilar biliary strictures after liver transplantation: cholangiography and percutaneous treatment.

Nonanastomotic hilar bile duct strictures developed in 16 of 152 patients who underwent liver transplantation. The type of pretransplantation liver disease did not significantly affect the likelihood of hilar stricture formation. Possible causes of hilar biliary strictures include hepatic artery occlusion, ductopenic arteriopathic rejection, and cytomegalovirus infection; however, five of the 16 patients had hilar strictures without these complications. Hilar strictures developed within 3 months after transplantation in 11 of the 16 patients. Strictures began as a slight common hepatic duct irregularity and progressed to mucosal cast formation and later to firm strictures. Fifteen of the 16 patients underwent percutaneous stricture dilation. Of 12 patients who no longer have stents, four have had no stricture recurrence for 12-30 months. Eight patients have had to undergo retransplantation or have died. Percutaneous dilations were most likely to result in patient bile ducts if strictures developed within 3 months after transplantation and in the absence of pretransplantation primary sclerosing cholangitis, ductopenic arteriopathic rejection, cytomegalovirus infection, or hepatic artery thrombosis.

Adolescent↗
PubMed1989

Chronic pancreatitis: reassessment with current CT.

A retrospective analysis was performed of contrast material-enhanced current-generation computed tomographic (CT) examinations in 56 patients with documented chronic pancreatitis. Dilatation of the main pancreatic duct was seen in 68% of cases, parenchymal atrophy in 54%, pancreatic calcifications in 50%, fluid collections in 30%, focal pancreatic enlargement in 30%, biliary ductal dilatation in 29%, and alterations in peripancreatic fat or fascia in 16%. The relatively small proportion of examinations in which no abnormalities were observed, 7%, differs from that in early reports, as does the absence of generalized pancreatic enlargement. Pancreatic ductal dilatation and parenchymal atrophy were notably more prevalent than reported previously. Nine of the 17 patients with focal pancreatic enlargement had calculi within the mass, which suggested benign disease; of the eight other patients, two of whom had coexistent carcinoma, this finding was absent and the masses were considered indeterminate at CT.

Chronic Disease↗
PubMed1987

Pseudobursae: a useful finding in patients with painful hip arthroplasty.

A retrospective review of 178 consecutive subtraction hip arthrograms (175 patients) was performed to evaluate the significance of cavities or bursal communications (or both) with the pseudocapsule in patients with painful hip arthroplasty. Bursae and/or communicating cavities were shown in 75 (43%) of the 175 patients. Communicating irregular cavities were noted in 12 patients (nine infected), and smooth bursae or bursalike structures were noted in 63 patients. The most frequent bursal locations were the greater trochanteric region (32/63), supraacetabular region (18/63), and iliopsoas (12/63). Three patients had multiple bursae. Six of the 18 acetabular bursae were associated with previous dislocations. Twenty-seven patients with bursae had no radiographic findings of loosening or infection. Of these 27, 12 (44%) responded to local injection of anesthetic into the bursa and were judged clinically to have bursitis. Arthrography, with aspiration from the bursae or cavities and injection of anesthetic, provides additional information regarding painful hip arthroplasty and may prevent unnecessary surgery.

Adult↗
PubMed1984

The efficacy of random digit dialing in selecting matched controls for a case-control study of pediatric cancer.

A study of random digit dialing as a method of control selection was conducted as part of a matched case-control study of risk factors for neuroblastoma. The study was conducted in 1981-1982 in the Greater Delaware Valley region. Participation involved parents submitting to a 2-4-hour telephone interview. Potential control telephone numbers were selected by substituting the last two digits of the case family's telephone number with randomly selected digits. Successive random telephone numbers were called until a family with a child matching the case by year of birth plus or minus three years and race who agreed to participate was identified. A total of 3,245 telephone numbers were dialed to select controls for 101 cases, an average of 32.1 telephone numbers per case. Among 1,908 residential households contacted, 25.5% refused to give information about household characteristics. Of households with known characteristics, 45% had children under 25 years of age and 14.9% had a child eligible for the study. Among 181 households invited to participate, 101 agreed. For 18.6% of all calls, residential respondents were randomly offered $10 as an inducement to participate. This inducement did not significantly influence participation rates among families invited to participate.

Adult↗
PubMed1984

CT features of nonfunctioning islet cell carcinoma.

To determine the computed tomographic (CT) characteristics of nonfunctioning islet cell carcinoma of the pancreas, the CT scans of 27 patients with that disease were reviewed. The pancreatic tumor was identified as a mass in 26 patients (96%). Demonstrated masses were 3-24 cm in diameter. Eight of the tumors (31%) were larger than 10 cm. Six tumors (22%) contained calcification. Of the 25 tumors evaluated with contrast enhancement, 20 became partially or diffusely hyperdense relative to nearby normal pancreatic tissue. Hepatic metastases were identified in 15 patients (56%), regional lymphadenopathy in 10 (37%), atrophy of the gland proximal to the tumor in six (22%), dilatation of the biliary ducts in five (19%), and dilatation of the pancreatic duct in four (15%). The CT appearances of the nonfunctioning islet cell tumors were compared with those of 100 ordinary (ductal) pancreatic adenocarcinomas. Although the two types of tumors were sometimes indistinguishable, features found to be more characteristic of islet cell carcinoma included a pancreatic mass of unusually large size, calcification within the tumor, and contrast enhancement of either the primary tumor or hepatic metastases. Involvement of the celiac axis or proximal superior mesenteric artery was limited to ductal carcinoma.

Adenoma, Islet Cell↗
PubMedDate not supplied

MRI of pancreatic islet cell carcinoma.

OBJECTIVE: The purpose of this study is to report the spectrum of MR findings of pancreatic islet cell carcinoma. MATERIALS AND METHODS: The MR scans of 33 patients with islet cell carcinoma were retrospectively reviewed. Magnetic resonance detected the primary tumor in 21 of 27 patients (78%) who had not had prior resection of their primary tumor. Mean tumor diameter was 7.1 cm (range 3.5-13.0 cm). RESULTS: In all patients, the primary tumor on T1-weighted images (TR/TE = 250/15) was of signal intensity equal to or lower than that of the adjacent normal pancreas. The primary tumor on T2-weighted images (TR/TE = 2,000/> or = 100) was of signal intensity the same as or higher than fat in 18 of 21 patients (86%) and had mixed signal intensity in the other 3 (14%). Hepatic metastases were found in 28 of 33 patients (85%). Liver metastases were categorized as "usual" (variably circumscribed, homogeneous lesions of medium signal intensity on T2-weighted images) in 19 of 28 patients (68%), necrotic in 8 of 28 (29%), hemorrhagic in 3 of 28 (11%), and calcified in 1 of 28 (4%). Extrahepatic metastases were found in 18 of 33 patients (55%). CONCLUSION: We conclude that MRI is an excellent modality for the diagnosis and routine follow-up of patients with islet cell carcinoma.

Adenoma, Islet Cell↗