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Biomedical subjects

G Paull

Publications and source records attributed to G Paull.

16 recordsLinked to original sources
PubMed2004

Non-valvular atrial fibrillation and stroke: implications for nursing practice and therapeutics.

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance and is increasing in prevalence due to the ageing of the population, and rates of chronic heart failure. Haemodynamic compromise and thromboembolic events are responsible for significant morbidity and mortality in Australian communities. Non-valvular AF is a significant predictor for both a higher incidence of stroke and increased mortality. Stroke affects approximately 40,000 Australians every year and is Australia's third largest killer after cancer and heart disease. The burden of illness associated with AF, the potential to decrease the risk of stroke and other embolic events by thromboprophylaxis and the implications of this strategy for nursing care and patient education, determine AF as a critical element of nursing practice and research. A review of the literature was undertaken of the CINAHL, Medline, EMBASE and Cochrane Databases from 1966 until September 2002 focussing on management of atrial fibrillation to prevent thrombotic events. This review article presents key elements of this literature review and the implications for nursing practice.

Anti-Arrhythmia Agents↗
PubMed2001

High-risk human papillomavirus is sexually transmitted: evidence from a follow-up study of virgins starting sexual activity (intercourse).

Genital human papillomavirus (HPV) infection is generally considered to be sexually transmitted. However, nonsexual spread of the virus has also been suggested. The goal of this study was to assess: (a) the role of sexual intercourse in the transmission of HPV; (b) the determinants for seroconversion; and (c) the correlation between HPV DNA, abnormal cervical cytology, and serological response to HPV16. One hundred virgins and 105 monogamous women were randomly selected from a population-based cohort study in Copenhagen, Denmark, in which the women were examined twice with 2-year interval (interview, cervical swabs, Pap smear, blood samples). The presence of HPV DNA was determined by GP5+/6+ primers based HPV-PCR-EIA. HPV 16 virus-like particles (VLP) antibodies were detected by ELISA. All of the virgins were both HPV DNA negative and seronegative to VLP16, except for one woman who was weakly HPV 6 DNA positive. Only those virgins who initiated sexual activity became HPV DNA positive and/or VLP16 positive. The most important determinant of HPV DNA acquisition was the number of partners between the two examinations. The only significant risk factor for HPV 16 VLP seroconversion among women acquiring HPV DNA was HPV type. Our results show that sexual intercourse is important in the transmission of HPV, and that HPV 16 VLP seroconversion and the development of cervical lesions only occur after HPV transmission. Remarkably, no cervical lesions were found in HPV 16 DNA positive women who had seroconverted. Although based on small numbers, this may suggest that the development of antibodies had a protective effect.

Adult↗
PubMed2000

Low-grade fibromyxoid sarcoma and hyalinizing spindle cell tumor with giant rosettes: a clinicopathologic study of 73 cases supporting their identity and assessing the impact of high-grade areas.

Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma characterized by bland histologic features and a paradoxically aggressive clinical course. The hyalinizing spindle cell tumor with giant rosettes (HSCT) is a closely related tumor characterized by the presence of giant collagen rosettes. Only a single example of a metastasizing HSCT has been reported. A small subset of both LGFMS and HSCT display areas of increased cellularity and atypia which qualify as intermediate- to high-grade sarcoma; the significance of these features has not been definitively assessed. We present the clinicopathologic features of 77 cases of LGFMS and HSCT to determine the degree of overlap of these two lesions, their biologic behavior, and the significance of the occasional presence of intermediate- to high-grade sarcoma within both. The patients (33 female, 40 male) ranged from 3 to 78 years of age (median, 34 yrs). Fourteen cases occurred in patients less than 18 years of age. The tumors measured from 1 to 23 cm (median, 4.5 cm) and occurred predominantly in the trunk and lower extremities in both the deep (66 cases) and superficial (7 cases) soft tissues. In 15 cases, the tumor was present > 1 year before diagnosis. All tumors showed predominantly the typical hypocellularity and bland cytologic features of typical LGFMS; however, areas of hypercellularity and nuclear enlargement and hyperchromatism were identified in 12 of 73 (16%) and 7 of 73 (10%), respectively. Necrosis and mitotic activity >5/50 high-powered fields (HPF) were present in 6 of 73 (8%) and 5 of 73 (7%), respectively. Epithelioid areas were present in 33 of 73 (45%) and rosettes in 22 of 73 (30%). Follow up (54 cases; range, 2-192 mos; median, 24 mos; mean, 38 mos) showed 5 recurrences, 3 metastases, and 1 death. The diagnosis of LGFMS or HSCT was made prospectively in 51 patients; none had metastatic disease. Two of the metastatic tumors were LGFMS and one was a HSCT. LGFMS may occur more often in the pediatric population and show a much wider histologic spectrum than previously thought. A significant number of LGFMS possess inconspicuous collagen rosettes characteristic of HSCT, indicating that these two tumors are ends of a common spectrum rather than distinct entities. HSCT, like LGFMS, are low-grade sarcomas with metastatic potential. The presence of focal areas of intermediate- to high-grade sarcoma does not portend a worse outcome in the short term. The better prognosis reflected in this study compared with previous ones might reflect the fact that all were initially diagnosed as sarcomas and treated with aggressive surgery. The fact that the only three patients to develop metastatic disease were patients whose LGFMS or HSCT was identified retrospectively supports this concept.

Adolescent↗
PubMed1999

The expanding clinical spectrum of desmoplastic small round-cell tumor: a report of two cases with molecular confirmation.

Desmoplastic small round cell tumor (DSRCT) is an aggressive neoplasm characterized by a consistent histological appearance, a unique immunohistochemical profile, and a specific chromosomal translocation. DSRCT is also hallmarked by distinctive clinical features. Most tumors arise in adolescent or young adult males, present as bulky abdominal masses, and diffusely spread along the peritoneal surface. We report two cases of DSRCT that do not fit this typical profile. One case involved the abdominal cavity of a 76-year-old woman. The other case arose in the parotid of a 22-year-old man. Histologically, the tumors showed the characteristic features of DSRCT. Immunohistochemically, the tumors showed positivity for cytokeratin, desmin, and neuron-specific enolase. Genetically, the tumors expressed the EWS-WT1 chimeric transcript. These two cases expand the differential diagnosis for poorly differentiated small-cell tumors that involve elderly patients or arise in the parotid. Moreover, they challenge the popular notion that DSRCT is a "blastomatous" tumor derived exclusively from the primitive mesothelium.

Abdominal Neoplasms↗
PubMed1996

Human papillomavirus DNA detection in cervical specimens by hybrid capture: correlation with cytologic and histologic diagnoses of squamous intraepithelial lesions of the cervix.

Human papillomavirus (HPV) DNA detection in cervical specimens was correlated with cytologic and histologic diagnoses for 151 women who were referred to the Johns Hopkins Hospital colposcopy clinic for evaluation of an abnormal Pap smear. HPVs were identified as "high-risk" or "low-risk" by Hybrid Capture. The final disease status was categorized as high-grade squamous intraepithelial lesion (HSIL) by histology (n = 26), low-grade squamous intra-epithelial lesion (LSIL) by histology (n = 43), equivocal [histology negative, cytology atypical squamous cells of undetermined significance (ASCUS) or higher, n = 42], and negative (both histology and cytology negative, n = 40). Thirty-five percent of disease-negative women and 84% of the women with biopsy-proven or equivocal disease were HPV-positive. Ninety-two percent of the HPV-positive women harbored high-risk HPVs, either high-risk HPVs alone (77%) or high-risk HPVs along with low-risk HPVs (15%). High-risk HPVs predominated in disease-negative as well as disease-positive women. Collection of specimens with a cytobrush was more efficient for HPV DNA detection than collection by cervicovaginal lavage. Large amounts of HPV DNA correlated with presence of HSIL or LSIL. For detection of HSIL, considering only brush samples, the sensitivities of abnormal cytology (ASCUS or higher), of high-risk HPVs, and of the two combined were, respectively, 87, 93, and 100%; the corresponding specificities were 30, 30, and 20%. HPV DNA detection may be most beneficial in populations with low HPV prevalence.

Adult↗
PubMed1994

PAPNET analysis of reportedly negative smears preceding the diagnosis of a high-grade squamous intraepithelial lesion or carcinoma.

One hundred fourteen cervical smears obtained from 18 women developing biopsy-proven high-grade squamous intraepithelial lesions and two with invasive squamous carcinomas were analyzed by two pathologists using the PAPNET neural network-based automated screening system (PAPNET Analyses A and B). The smears were originally reported as negative and had been previously rescreened and reclassified according to The Bethesda System. Using the PAPNET video displays of 128 potentially abnormal cellular images per smear, each reviewer (PAPNET A and B) determined whether a smear required conventional rescreening. Results of the PAPNET triage were compared with the reclassification diagnoses of the smears by conventional microscopy. PAPNET Analysis A selected eight (14%) smears reclassified as negative, 25 (69%) as atypical squamous cells of undetermined significance, and 15 (71%) as squamous intraepithelial lesions (SIL) for rescreening. In PAPNET Analysis A, two (10%) SILs were not selected for rescreening, and four (19%) were considered unsatisfactory for analysis. PAPNET Analysis B selected 21 (37%) smears reclassified as negative, 25 (69%) as atypical squamous cells of undetermined significance, and 18 (86%) as SIL for review. In PAPNET Analysis B, two (10%) SILs were missed, and one (5%) smear was unsatisfactory for analysis. Each PAPNET analysis selected smears for rescreening in 19 (95%) of 20 patients and detected SILs in 10 patients that were missed in the original screening. Using PAPNET, SILs would have been detected a median of 56 months (PAPNET A) and 62 months (PAPNET B) before their actual discovery. These preliminary data suggest that PAPNET may help detect SILs missed in routine cytologic screening.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1988

Gastric and esophageal Campylobacter pylori in patients with Barrett's esophagus.

Campylobacter pylori organisms were found with similar frequency in the stomachs of patients with Barrett's esophagus and in age- and sex-matched controls (10 of 26 vs. 11 of 26). Campylobacter pylori was also observed in esophageal Barrett's mucosa in some patients with gastric C. pylori, but not when gastric infection was absent (4 of 10 vs. 0 of 16). Campylobacter pylori was not detected in esophageal squamous mucosa from patients with Barrett's esophagus or in 25 non-Barrett's patients with gastric C. pylori and histologic changes of esophageal reflux. Overall frequency of ulceration in Barrett's esophagus was 35% (9 of 26), and frequency of ulceration was similar whether or not C. pylori was noted in gastric or Barrett's mucosa.

Adult↗
PubMed1988

Reported binding of monoclonal antibody RAP-5 to formalin-fixed tissue sections is not indicative of ras p21 expression.

RAP-5 is a monoclonal antibody that has been shown to be immunoreactive with human ras gene product p21 in solid-phase radioimmunoassays and Western blots. RAP-5 binding in excess of that of control monoclonal antibodies to formalin-fixed tissue sections of several types of human tumors has been reported, and this binding has been interpreted as indicating p21 expression. We report that high concentrations of control monoclonal antibodies duplicated exactly the immunohistochemical staining pattern of RAP-5 on formalin-fixed tissue sections and that RAP-5 staining was not competitively inhibited by either the portion of p21 it was raised against or by the thyroglobulin-conjugated peptide used as immunogen. In an enzyme-linked immunosorbent assay, RAP-5 also showed greater nonspecific binding to poly-L-lysine and to polystyrene wells than did control antibodies. We conclude that RAP-5 binding to formalin-fixed tissue sections is nonspecific and not indicative of p21 expression.

Antibodies, Monoclonal↗
PubMed1988

Campylobacter pylori: a newly recognized infectious agent in the gastrointestinal tract.

Recent experience with the gastritis-associated organism Campylobacter pylori is reviewed, placing special emphasis on pathologic aspects. C. pylori is a spiral, gram-negative, urease-producing bacillus that has been found to infect the stomach in many people. C. pylori organisms are readily seen overlying the gastric epithelium, often in large numbers. Demonstration in gastric biopsies with silver stains is most vivid, but other faster, simpler stains such as Giemsa, acridine orange, and, at times, hematoxylin-eosin are satisfactory for routine purposes. The frequent occurrence of C. pylori in persons with chronic active gastritis has been confirmed in medical centers around the world. In addition, epidemiological, serological, pathological, and clinical observations suggest that C. pylori infection occurs in stomachs of duodenal ulcer patients with a frequency approaching 100%, and the infection may be relevant to pathogenesis or therapeutic response in duodenal ulcer disease. C. pylori probably also causes an acute infectious gastritis associated with hypochlorhydria. C. pylori still requires extensive investigation to establish its pathogenic role in upper gastrointestinal disorders, but evidence continues to accumulate that such a role exists and that it may be important.

Antibodies, Bacterial↗
PubMed1986

Prognosis of untreated stage A1 prostatic carcinoma: a study of 94 cases with extended followup.

Previously we showed that in cases of stage A prostatic cancer, if the tumor involved 5 per cent or less of the tissue and was not high grade (stage A1), only 2 per cent of the tumors progressed at 4 years. The current study investigated a larger group of 94 men with stage A1 disease and extended followup. While 26 men (mean age 75 years) died of other causes less than 4 years after diagnosis, of the 50 men who remained at risk 8 years or longer from the time of diagnosis 8 (16 per cent) had progression of disease. The intervals from diagnosis to progression ranged from 3.5 to 8 years, with 6 of the 8 patients dying of the cancer. Neither volume nor grade predicted progression, since of the 8 tumors that progressed 4 involved less than 1 per cent of the tissue and 6 were low grade. Based on these findings we conclude that stage A1 tumors progress at longer intervals from diagnosis and at lower frequency than stage A2 tumors. However, patients with stage A1 disease are not entirely free of risk of progression, and because 16 per cent of the men in this study who were at risk 8 years or longer experienced progression this factor must be recognized in the management of young men with stage A1 tumors.

Adenocarcinoma↗
PubMedDate not supplied

Vaginal intraepithelial neoplasia. Reproducibility of pathologic diagnosis and correlation of smears and biopsies.

Masked slides of 124 vaginal smears and 70 corresponding biopsies obtained from 45 patients with a reported cytologic diagnosis of vaginal intraepithelial neoplasia (VAIN) were examined by two pathologists to assess the interobserver reproducibility and histopathologic correlation of cytopathologic diagnoses of VAIN. The cytopathologic diagnoses by the two pathologists were identical in 94 (76%) cases and matched the originally reported diagnosis in 45 (46%) cases. The histopathologic diagnoses by the two pathologists agreed in 47 (67%) cases and matched the originally reported diagnosis in 35 (55%). The consensus cytopathologic and histopathologic diagnoses rendered by the pathologists agreed within one grade in 49 (70%) cases. A consensus histopathologic diagnosis of VAIN 2 was rendered in only 1 (10%) of 10 cases in which the cytopathologic diagnosis was VAIN 2. These results suggest that the cytopathologic and histopathologic grading of VAIN is moderately reproducible. Because (1) combining VAIN 2 and 3 under the diagnosis of high grade squamous intraepithelial lesion provided a slight improvement in diagnostic reproducibility and cytopathologic-histopathologic correlation and (2) the cytopathologic diagnosis of VAIN 2 was employed rarely and rarely confirmed histopathologically, we advocate the use of the term high grade squamous intraepithelial lesion to designate VAIN 2 and 3.

Adult↗