Biomedical subjects
Publications and source records attributed to I Stewart.
Total calculated uniform liver doses of up to 150 Gy were achieved using glass yttrium-90 microspheres administered via the hepatic artery and targeted to tumour using angiotensin II in seven patients with colorectal liver metastases. No toxicity was observed. Hepatic metastatic progression was delayed in six patients. Median survival was 11 months (range 5-25 + months).
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The concept of cardiac rehabilitation following myocardial infarction is not a new one but is now at last gaining acceptance as an essential part of the service to the coronary patient. Its aim is to restore the effectiveness of post-infarct patients by ensuring that they are well adjusted, well educated and fit and thereby best able to cope with the long term consequences of their ischaemic heart disease. The first essential factor for good rehabilitation is patient education. Studies have shown high levels of distress and anxiety after infarction and to a large extent this is related to lack of information. Where patients have been given adequate information concerning their condition and treatment there is a high level of patient satisfaction and greater compliance. It must be appreciated that stress and anxiety impair the patient's ability to assimilate information and therefore repeated reinforcement is necessary. During the in-hospital period, the staff who are caring for the patient are constantly changing and while there is a role for all to educate the patient, the use of a cardiac liaison sister provides a continuity throughout the early recovery period to ensure that the education process is adequate. The use of written material and both audio and video tapes is also helpful. It is also important for the liaison sister to extend her role to the patient's immediate family, who also require information, and finally the liaison sister can provide a link into the post discharge phase, to answer the many questions that arise at this time, and to provide encouragement to the patient who is attempting to modify his lifestyle by stopping smoking, changing his diet and taking regular exercise. The use of exercise training is the second vital ingredient for adequate rehabilitation. This begins in earnest after the 6-week assessment, which can provide information on which to base an exercise prescription. The majority of patients enrolled within exercise programmes are medically stable and relatively symptom-free. There is increasing evidence that those with extensive myocardial damage, left ventricular dysfunction or failure, and ongoing myocardial ischaemia may also benefit. Traditional training programmes have been hospital based and have used mainly aerobic exercise. However, home based programmes should not be discounted where they may be more economical, more convenient, and improve patient compliance. Similarly, circuit training with weights has been shown to improve aerobic endurance and muscle strength and to have additional benefits in improved treadmill time compared with traditional aerobic programmes.(ABSTRACT TRUNCATED AT 400 WORDS)
Fifty-five consecutive patients, with colorectal metastases confined to the liver, underwent surgical placement of a hepatic artery catheter. At angiography, abnormal hepatic arterial anatomy was present in 33% of patients. In the majority of patients, the hepatic artery catheter was inserted in the conventional manner. In eleven patients with unusual arterial anatomy, a saphenous vein graft was used to create a conduit for the catheter. Satisfactory perfusion was obtained in all patients.
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Salivary gland cavernous haemangiomas are relatively uncommon in the child and even rarer in the adult, and provide diagnostic difficulties. This paper demonstrates how the diagnosis can be established using sonography and red blood cell (RBC) scintigraphy.
Thirty-six patients in whom peripheral cavernous haemangioma was clinically suspected were examined by 99mTc red blood cell scintigraphy. Twenty-five of these patients had a palpable lump, and they also underwent an ultrasound examination. Seven patients also had computed tomography and angiography was performed in one patient prior to surgery. Twenty-nine patients had positive scintigrams showing 35 haemangiomas. The ultrasound features were variable and of little value except in anatomical localization. Computed tomography did not add significant extra information. We conclude that 99mTc red blood cell scintigraphy is the preferred diagnostic technique in the investigation of suspected peripheral haemangiomas.
First-void urine (FVU) sediments of 240 men were tested for Chlamydia trachomatis antigens by two enzyme immunoassays, TestPack Chlamydia (15 min) and Chlamydiazyme (3.5 h), and the results were compared with urethral swab culture results. The sensitivity and specificity on FVU sediment for TestPack Chlamydia were 76.2% (32 of 42 specimens) and 95.5% (189 of 198 specimens) versus 81.0% (34 of 42 specimens) and 96.5% (191 of 198 specimens) for Chlamydiazyme, respectively. Rapid, on-site detection of chlamydial antigen in male FVU would shorten the infectious period by hastening diagnosis and treatment.
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It is known that an increased level of red blood cell 2,3-diphosphoglycerate (DPG) shifts the oxyhemoglobin dissociation curve to the right, thus allowing a greater unloading of oxygen at the tissue level. It has been hypothesized that phosphate might help increase VO2max by increasing 2,3-DPG level. Eight trained cyclists underwent three cycle ergometer tests (control, placebo, and experimental) to determine whether phosphate ingestion had any positive effect on VO2max, time to exhaustion, serum 2,3-DPG, and serum phosphate levels. We found no change between the control, placebo, or experimental conditions in pretest serum phosphate levels, but we did find increases in 2,3-DPG levels in the phosphate condition (p less than .05), which suggests that even a small amount of phosphate could increase levels of 2,3-DPG. We also found significant differences in VO2max between the control (p less than .05) and placebo (p less than .02) conditions and also in time to exhaustion between the three conditions (p less than .05). We suggest that phosphate may have an ergogenic effect, but clearly more work needs to be undertaken to ascertain the amount of phosphate required and the magnitude of the effect.
By using commercially available spectrophotometric and immunofluorescent immunoassays, Chlamydia trachomatis antigens were detected in first-void urine (FVU) sediments from 224 men attending a sexually transmitted disease clinic at a frequency of 81.6%-86.8% compared with 86.8% (33/38) positive by urethral swab culture (P less than .05). Endocervical cultures from 228 women attending a gynecology clinic yielded 92.3% (12/13) positive compared with 61.5%-76.9% for urine samples in three antigen-detection assays. Culturing urine from either gender yielded low positivity rates (23.7% for men, 15.4% for women). Defining truly infected patients as positive by culture or by any two of the three antigen tests, all assays were 100% specific. Immunodiagnostic testing of male FVU sediment appears to be a reliable, rapid, nontraumatic method for diagnosing chlamydia infection.
A 48-year-old man with colorectal liver metastases underwent insertion of an hepatic arterial infusion catheter for regional chemotherapy. Postoperative hepatic arterial perfusion scintigraphy showed that only part of the liver was being perfused by this route. Chemotherapy was administered weekly via the catheter. In effect, part of the liver received regional chemotherapy, whereas the remainder of the organ was exposed to systemic chemotherapy. Ultrasonography demonstrated shrinkage of the metastases in the area of liver receiving regional therapy, whereas disease progression occurred in the region of liver receiving 'systemic' treatment. This patient demonstrates that tumour may respond to regional chemotherapy despite disease progression on systemic therapy and suggests that a controlled trial would yield valuable data.
A case of primary rectal lymphoma is presented. Pre-operative histological diagnosis is difficult, and examination of the fresh specimen, using immunocytochemical and gene rearrangement techniques, is necessary to establish the precise nature of the lesion. Surgical excision is the mainstay of treatment.
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We have evaluated the sensitivity, specificity and accuracy of laparoscopy under general anaesthesia, ultrasound and computed tomography (CT) in detecting intra-abdominal metastases in 90 consecutive patients with carcinoma of the oesophagus or cardia. Metastases were histologically confirmed as hepatic in 25 patients, nodal in 35 and peritoneal in nine. All investigations had high specificity (86-100 per cent) for each type of metastasis. Laparoscopy was found to be significantly more sensitive (P less than 0.01; P less than 0.02) and more accurate (P less than 0.01; P less than 0.01) than either ultrasound or CT, respectively, with regard to hepatic status. Although laparoscopy performed best with regard to nodal metastases, this reached statistical significance only when sensitivity of ultrasound was compared (P less than 0.01). Neither ultrasound nor CT detected any peritoneal metastases, although laparoscopy detected eight out of nine, giving a sensitivity of 89 per cent and an accuracy of 98 per cent. There was no morbidity or mortality associated with laparoscopy, which offers a safe, reliable method of determining intra-abdominal status and may obviate the need for surgery in some patients with malignant dysphagia.
Shielding an ovary and part of the uterus of mice during irradiation allowed chimeric mice, reconstituted with rat or mouse bone marrow (respectively, RBM and MBM chimeras), to be studied in a subsequent pregnancy. Some of the granulated metrial gland (GMG) cells which differentiated in the RBM chimeric mice were rat GMG cells, showing the contribution of donor bone marrow precursors to the uterine response to pregnancy. Rat and mouse GMG cells were found in the maternal blood spaces of the placental labyrinth adjacent to the degenerate layer 1 trophoblast. This suggests that both rat and mouse GMG cells exhibit cytotoxic activity against the mouse trophoblast.
Angiomyolipomas produce pathognomonic appearances on modern imaging methods and a tissue diagnosis is no longer required particularly when multiple tubers can be confidently diagnosed and if a CT brain scan shows periventricular calcifications. As the renal tumours are benign every effort must be made to preserve normal renal tissue. Symptomatic or large tumours can be effectively treated by transcatheter embolisation with a reduction in the size of the tumour and control of intratumoural haemorrhage.
The enzyme-amplified immunoassay IDEIA (CellTech Diagnostics), which measures lipopolysaccharide antigen, and Chlamydiazyme (Abbott Laboratories, North Chicago, Ill.), which measures several antigenic components of Chlamydia trachomatis, were compared for specimens from urethral swabs from 235 men attending a clinic for sexually transmitted diseases (culture prevalence of 14.9%) and 458 endocervical swabs from women attending planned parenthood and obstetrics-gynecology clinics (culture prevalences of 5.9 and 7.7%, respectively). Compared with cell culture, the percent sensitivites, specificities, and positive and negative predictive values for IDEIA were 62.5, 99.5, 95.2, and 94.3%, respectively, for specimens from men and 96.3, 97.9, 74.3, and 99.8%, respectively, for specimens from women; results for Chlamydiazyme for specimens from men were 81.8, 99.5, 96.4, and 97.1%, respectively, and for specimens from women, results were 85.2, 99.3, 88.5, and 99.1%, respectively. Although the specificities of IDEIA and Chlamydiazyme were comparable, the sensitivity of IDEIA appeared higher for women (96.3%) than for men (67.5%), while the sensitivities of Chlamydiazyme were similar for men (81.8%) and women (85.2%). Western blot (immunoblot) analysis of the detector reagents from the two immunoassays indicated that the differences in performance observed for the two immunoassays may be due to measurement of different antigens.