Biomedical subjects
E W Campbell
Publications and source records attributed to E W Campbell.
Training general internists and "STARS".
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Mapping of low-frequency chimeric yeast artificial chromosome libraries from human chromosomes 16 and 21 by fluorescence in situ hybridization and quantitative image analysis.
Yeast artificial chromosome (YAC) clones from low-frequency chimeric libraries of human chromosomes 16 and 21 were mapped onto human diploid fibroblast metaphase chromosomes using fluorescence in situ hybridization (FISH) and digital imaging microscopy. YACs mapped onto chromosome 21 were selected to provide subregional location and ordering of known and unknown markers on the long arm of chromosome 21, particularly in the Down syndrome region (q22). YACs mapped onto chromosome 16 were selected to overlap regions spanning chromosome 16 cosmid maps. YAC clones were indirectly labeled with fluorescein, and the total DNA of the chromosome was counterstained with propidium iodide. A single image containing both the FISH signal and the whole chromosome was acquired for each chromosome of interest containing the fluorescent probe signal in a metaphase spread. From the digitized image, the fluorescence intensity profile through the long axis of the chromosome gave the total chromosome length and the probe position. The map position of the probe was expressed as the fractional length (FL) of the total chromosome relative to the end of the short arm (FLpter). From each clone hybridized, 20-40 chromosome images were analyzed. Thirty-eight YACs were mapped onto chromosome 16, and their FLs were distributed along the short and long arms. On chromosome 21, 47 YACs were mapped, including 12 containing known markers. To confirm the order of a dense population of YACs within the Down syndrome region, a two-color mapping strategy was used in which an anonymous YAC was located relative to one or two known markers on the metaphase chromosome.(ABSTRACT TRUNCATED AT 250 WORDS)
Ureteral injury due to blunt and penetrating trauma.
In a period of twenty-seven months, 15 patients with ureteral trauma were encountered, leading us to believe that there is an increasing incidence of these injuries. The injuries were caused by blunt trauma in 3 patients and gunshot wounds in 12. All patients sustained injuries to other organs as well as the ureter. The diagnosis of ureteral injury was frequently delayed beyond the day of presentation (33%) primarily due to the number and severity of associated injuries. The most accurate methods of diagnosis were surgical exploration and retrograde pyelography. Intravenous pyelography and abdominal computerized tomography scanning were diagnostic in only 33 percent of cases. Hematuria was present in only 63 percent of patients who had no other genitourinary injuries, emphasizing the lack of reliability of this sign in ureteral trauma.
Zygomycosis mimicking paranasal malignancy.
A case of zygomycosis involving the maxillary sinus in a normal host and mimicking paranasal malignancy is presented. Computed tomographic images showing destruction of adjoining bony structures and histologic features of fungi are described and presented. A successful outcome was achieved with amphotericin B irrigation and parenteral amphotericin B. Nasal biopsy should be advised by both radiologists and clinicians in all cases of lesions that look like malignancy in the sinus areas before a treatment modality is initiated.
Current status of cancers of the bladder and prostate.
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Trans-acting factors in chromosomal instability.
The hypothesis that trans-acting factors affect chromosome stability was explored using human X Chinese hamster somatic cell hybrids. Two types of hybrids were examined. In either case, the human parent consisted of human diploid fibroblasts, the chromosomes of which tended to be lost from the hybrid cell. Comparisons were made between hybrid clones in which the hamster parent had a very stable karyotype (line CHO) and clones from a hamster parent with an unusual ongoing unstable karyotype (line CHX). Chinese hamster-human hybrid cell clones were expanded, and metaphase spreads were analyzed with an in situ hybridization procedure that uses biotin-labeled human genomic DNA as probe. Analyses of chromosome numbers and interspecies translocations were made after 20, 60, and 100 population doublings. Throughout the experiments, the generation of human-hamster-translocated chromosomes was more frequent in the hybrid cells with the CHX background. In addition, these cells also generated human acentric fragments, which were rare in cells with the CHO background. These results favor explanations for the instability of the CHX line that involve ongoing production of a diffusible clastogenic factor.
Fatal clostridial pancreatitis following ERCP and percutaneous needle biopsy.
A patient with a large necrotic pancreatic carcinoma underwent ERCP and percutaneous biopsy of the cancer and of a suspected hepatic metastasis. On the second day, she developed a massive hemolysis with a 50% drop of hemoglobin level and a rise of serum bilirubin level from 1.3 to 37.5 mg%. Gas was noted on followup CT scan of the pancreas. Clostridium perfringens was found by needle aspiration of the pancreas and on multiple blood cultures. Death resulted from sepsis on the fourth day. Since ERCP and percutaneous needle biopsy of the pancreas are being done with increasing frequency, and since this complication has not been previously described, this case report is presented.
Magnetic resonance imaging (MRI) in staging of the prostatic cancer.
In a prospective study, the role of MRI in the staging of prostatic cancer has been assessed in 32 patients. The results of MRI has been compared with those conventional staging modalities for prostatic cancer including pelvic CT, cystoscopy, bimanual examination and biopsy of the prostate. The final clinical and/or pathologic staging was obtained. The results of CT were compared with those of MRI in a blind fashion. In 22 of Stage A and B neither MRI nor CT were able to define the extension of the disease. In no cases were results of CT superior to the MRI. However, in 10 cases, the seminal vesicles were involved and these cases were interpreted as stage C. In exploration 2 out of 10 cases had metastases shown by MRI. It is concluded that MRI is more sensitive in revealing the detail of the seminal vesicles thereby detecting the bulk of the tumor and the extension of cancer into the soft tissue of the lymphadenopathy of this organ. The role of MRI in the detection of and the utilization of paramagnetic media remains to be studied.
Persistent clot anuria complicating renal transplant biopsy.
Serious morbidity from renal transplant biopsy is reported to be infrequent. However, 4 of 43 patients who had renal transplant biopsy between July, 1981, and March, 1984, experienced anuria from upper urinary tract obstruction by blood clots. Although these clots usually dissolve, 3 patients (7%) experienced persistent clot anuria and deterioration of renal function. Awareness of this complication is important. Retrograde pyelography and ureteral catheterization are preferred primarily for diagnosis and treatment. Percutaneous techniques are reserved for those cases in which the ureter cannot be catheterized cystoscopically.
Expansion of inadequate volume of coagulum for pyelolithotomy: an experimental and clinical study.
The unit volume (4 to 18 ml.) of cryoprecipitate provided by the blood bank is sometimes inadequate to fill a given pelviocaliceal system. The effect of diluting the cryoprecipitate with urine, saline and water to increase this volume was investigated. Samples of cryoprecipitate were expanded with urine, saline solution and water in proportions of 3:1 and 1:1 at 37C. One part of 10 per cent calcium chloride was added to the various dilutions for each 20 parts of unexpanded cryoprecipitate. All samples resulted in tenacious coagula. The mean generation time of the coagula was 2.25 minutes with water expansion, and 3 to 4.5 minutes when diluted with urine and saline. The mean tensile strength decreased 44 to 64 per cent with water expansion, and 7 to 32 per cent when diluted with urine and saline. Water expansion is not recommended because of the marked decrease in generation time and tensile strength. In patients cryoprecipitate expanded with urine or saline provided tenacious coagula.
Transfusion pattern of fresh frozen plasma in a medical school hospital.
364 units of fresh frozen plasma (FFP) used at the Medical College of Ohio Hospital between April and July 1982 were analyzed for their pattern of use. According to the criteria developed for the survey, 33% of the units were used for blood pressure support, 34% were used for clotting support, 14% were used for the combined reasons of blood pressure and clotting support, 11% of the units were used during therapeutic pheresis, and the remaining 7% were used for unidentified reasons. 39% of the FFP were given with red blood cells. Since FFP transfusions carry potentially more serious adverse effects than albumin/plasma protein fractions, their use as volume expanders, or to reconstitute whole blood, should be discouraged.
Further simplification of cryoprecipitate coagulum pyelolithotomy without thrombin.
Deletion of thrombin simplifies the surgical procedure of cryoprecipitate coagulum pyelolithotomy and subsequently eliminates the proposed risk factors associated with thromboembolism. The ideal ratio is 20 parts of cryoprecipitate to 1 part of 10% calcium chloride. The modified technique is presented.
Sources of fibrinogen for coagulum pyelolithotomy, without thrombin. A comparative study.
Coagulum pyelolithotomy without the use of thrombin is simplified by using single donor plasma, fresh frozen plasma, and "maxi-cryoprecipitate" (expanded cryoprecipitate) as sources of fibrinogen. The physical properties, including generation time, breaking point, and tensile strength were compared for different coagula. An illustrative case is presented for each fibrinogen source. The tensile strength of fresh frozen plasma coagulum was 15 per cent (17 Gm/cm2) and of maxi-cryoprecipitate 29 to 33 per cent (31-46 Gm/cm2) that of cryoprecipitate, but both were strong enough for clinical use. The preferred source of fibrinogen is cryoprecipitate followed by maxi-cryoprecipitate and fresh frozen plasma in that order. Twenty parts of fibrinogen to one part of 10 per cent calcium chloride provided the shortest generation time and the greatest tensile strength in each of the experiments, and is used exclusively by the authors at present. Single donor plasma is not recommended as a source of fibrinogen for coagulum generation clinically.
Hydrocele following treatment for Hodgkin's disease.
Thirteen Hodgkin's disease patients developed hydrocele after treatment with radiotherapy (12 patients) or chemotherapy (one patient). An additional patient developed testicular swelling following radiotherapy and chemotherapy. Eleven of 13 patients were staged with laparotomy (nine initially, two at restaging) which included pelvic and aortic node biopsies prior to the development of hydrocele. Five of the patients developed radiation-related pericarditis. These data suggest that staging and treatment of Hodgkin's disease may disrupt pelvic lymphatic flow and lead to hydrocele formation. The high incidence of treatment-related pericarditis may suggest unusual sensitivity to radiation in this group of patients.
Establishment of a geriatrics curriculum.
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Role of anchorage in the expression of tumorigenicity of untransformed mouse cell lines.
Cultured mouse cells were tested for tumorigenicity in nude mice with both a conventional assay (injection of cell suspensions) and a new test involving implantation of cells grown on gelatin sponges. Sublines of Balb/3T3 cells, obtained from different sources, varied in their tumorigenic potential with either assay. One subline (A) formed distinctive precancerous nodules only in the sponge assay; these nodules often became progressive after a latent period of 3-4 months. However, suspensions of cells of this subline also caused tumors after a similar latent period, but no nodular phase preceded tumor formation. Another subline of Balb/3T3 (M) has failed to form tumors in either assay. The Balb/3T3 sublines did not differ in vitro properties, such as low saturation density, failure to grow in methylcellulose, and monolayer morphology. A second experimental approach involved tests on nude BALB/c mouse-embryo fibroblasts at various passage levels. The cells were passaged from primary culture, through crisis, to heteroploid, established cell lines. Tumorigenicity was demonstrable earlier in the sponge assay, at which time in vitro parameters putatively associated with malignant behavior were unchanged. Possible relationships with the in vivo phenomenon of solid-surface sarcomagenesis are discussed.