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Biomedical subjects

J A Jordan

Publications and source records attributed to J A Jordan.

At least 55 records · Page 3Linked to original sources
PubMed1996

Identification of human parvovirus B19 infection in idiopathic nonimmune hydrops fetalis.

OBJECTIVE: This retrospective study was designed to determine the incidence of B19 associated with idiopathic nonimmune hydrops fetalis by use of a sensitive molecular tool, the polymerase chain reaction assay. STUDY DESIGN: Placental and fetal tissues from 57 cases of nonimmune hydrops fetalis were analyzed for B19 deoxyribonucleic acid. Thirty-four of these cases were classified as idiopathic. The remaining 23 cases had known, noninfectious-based causes. RESULTS: Eighteen percent of all cases (6/34) of idiopathic nonimmune hydrops fetalis contained B19 deoxyribonucleic acid. In contrast, none of the 23 cases of known, noninfectious-based nonimmune hydrops fetalis examined contained any B19 deoxyribonucleic acid. Presence of the virus was confirmed in each of the six cases by either B19-specific deoxyribonucleic acid in situ hybridization or immunocytochemistry. However, histologic examination was unsuccessful at detecting characteristic viral-like inclusions in one third of the cases. CONCLUSION: Eighteen percent of cases of idiopathic nonimmune hydrops fetalis contained B19 deoxyribonucleic acid. This significant finding demonstrates the usefulness of polymerase chain reaction to aid in the differential diagnosis of this disease.

Base Sequence↗
PubMed1996

Vulvoperineal reconstruction after excision of anogenital multifocal intraepithelial neoplasia ("MIN").

Over the past 7 years, 12 women have been treated utilising a radical surgical approach for extensive vulval involvement as a component of multifocal intraepithelial neoplasia (MIN) of the female genital tract. The patients were analysed with respect to the anatomical site of involvement, age, presenting complaints and their duration, colposcopic examination, histopathology and surgical treatment. Gynaecologists, general surgeons and plastic surgeons were involved in the surgical treatment which was an initial colostomy followed by a definitive vulvoperineal resection and simultaneous vulval reconstruction using meshed split skin grafts or a combination of skin grafts and local flaps. 17 vulvoperineal reconstructions were done for 12 patients. Three had an incomplete histopathological clearance at the initial operation. Apart from these three patients, one had recurrence of symptoms alone, without any evidence of MIN, which was possibly due to human papilloma virus infection. One patient developed malignant squamous invasion 4 years later, which was cured with surgical excision and reconstruction. Colostomy closure was done after achieving local control of the disease. This staged approach does achieve the objectives of eliminating disease and alleviating symptoms. It preserves function and attempts to reconstruct normal anatomy without compromising the principles of surgical oncology and results in a high patient satisfaction.

Adult↗
PubMed1996

Parvovirus B19 infection in patients with hemophilia.

BACKGROUND: The long-term consequences of parvovirus B19 infection in transfusion recipients are not known, and thus the value of B19 screening of blood donors remains unresolved. Hemophiliacs, at risk for B19 through their chronic exposure to clotting factor concentrates, have frequent, close medical follow-up and thereby constitute an ideal group in which to study the hematologic sequelae of B19 infection. STUDY DESIGN AND METHODS: An enzyme-linked immunosorbent assay was used to detect B19 IgG and IgM and the polymerase chain reaction was used to detect B19 DNA in frozen, stored plasma samples, obtained between 1987 and 1994, from 136 subjects with hemophilia, including 71 who were human immunodeficiency virus (HIV)-positive and 65 who were HIV-negative. Then the results of the tests were compared with clinical hematological data and blood product usage data. RESULTS: B19 seroprevalence in the hemophilic cohort was 81.6 percent (111/136), including 74.6 percent (53/71) of HIV-positive and 89.2 percent (58/65) of HIV-negative hemophiliacs. It was not affected by age, type or severity of hemophilia, HIV status, CD4 number, or yearly blood product usage. Only 1 (0.7%) of the 136 samples was positive for B19 IgM and none was positive in polymerase chain reaction for B19 DNA. After adjusting for HIV status, there were no differences between B19-positive and B19-negative hemophiliacs in hematologic values, CD4 counts, or blood product use. CONCLUSION: Although B19 IgG seroprevalence in this hemophilic cohort is high and indicative of past B19 infection, there is no detectable B19 viral activity or any associated long-term clinical or hematologic sequelae.

Adult↗
PubMed1996

Vulvar intraepithelial neoplasia: long term follow up of treated and untreated women.

OBJECTIVE: To investigate the long term outcome of patients with vulvar intraepithelial neoplasia. DESIGN: A retrospective study using information obtained from patient casenotes. SAMPLE: One hundred and thirty-three women with a primary diagnosis of vulvar intraepithelial neoplasia (VIN), identified during a 15-year period. RESULTS: The diagnosis of vulvar intraepithelial neoplasia increased throughout the study period. Human papilloma virus changes were noted in 104 patients (78%); these women were significantly younger than those without (P < or = 0.001). Nineteen (14%) were managed by observation or medical treatment and the remainder by surgical methods. Histological or symptomatic recurrence after surgical treatment occurred in 55 (48%). When disease recurred, it usually did so within four years of treatment. Recurrence was more common following laser vapourisation than after local excision (75% vs 40%; P < or = 0.01). Progression to invasive disease occurred in nine patients (7%), none of whom were in the group being observed. Four deaths occurred in this group, three from gynaecological malignancies of the lower genital tract. CONCLUSION: Patients with vulvar intraepithelial neoplasia require long term follow up, and the risk of invasion may be higher than previously thought. Surgical treatment when required should be by excisional rather than ablative methods in most instances. In selected cases it is also possible to safely manage patients by more conservative methods.

Adolescent↗
PubMed1996

Vulvar intraepithelial neoplasia with superficially invasive carcinoma of the vulva.

OBJECTIVE: To investigate the long-term outcome of patients presenting with vulvar intraepithelial neoplasia (VIN) with superficially invasive carcinoma of the vulva (SICa). DESIGN: A retrospective study using information obtained from patient case notes. SAMPLE: Twenty-six women found at presentation to have VIN in association with superficially invasive carcinoma were identified during a 15-year period. RESULTS: Pruritus vulvae was the most frequent presenting symptom in 18 patients (69%). Sixteen women (61.5%) had multiple symptoms. Features noted at vulvar examination were variable and none were pathognomonic of either VIN or of superficial invasion. All patients had VIN 3 in association with a superficially invasive carcinoma. Histological changes associated with human papillomavirus were found in 19 (73%) women. Half had a co-existent or previous abnormality of the lower genital tract. Local excision was the most frequent initial treatment (n = 9 [35%]). Mean follow up time was 65 months (range 12-174). Disease persisted after primary treatment in five women (19%). Both histological recurrence (of either VIN or SICa) or symptomatic recurrence occurred in 10 patients (38%). All patients who experienced recurrence did so within 36 months of treatment. Overall, 12 patients (46%) relapsed (histological or symptomatic recurrence); the mean time was 18 months. Fourteen patients (54%) were managed satisfactorily by their initial treatment. One patient died of recurrent cervical cancer. Three progressed to frankly invasive disease: two (aged 31 and 39 years) with carcinoma of the vulva and one aged 34 years with carcinoma of the perianal margin. All are alive and well after treatment. One patient had recurrence of superficially invasive carcinoma treated by local excision with no further problems. No episode of metastasis via lymphatic or vascular channels has been seen. CONCLUSIONS: Patients with superficially invasive carcinoma of the vulva may be safely treated by local excisional methods without recourse to lymphadenectomy. Relapse after primary treatment is common, and there appears to be a significant risk of progression to frankly invasive carcinoma.

Adult↗
PubMed1996

The effect of directed biopsy on the atypical cervical transformation zone: assessed by digital imaging colposcopy.

OBJECTIVE: To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones. DESIGN: A prospective randomised clinical trial. SETTING: Academic Unit colposcopy clinics in Birmingham. PARTICIPANTS: One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis. METHODS: Three-way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra-epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy. RESULTS: No significant difference in change in lesion size (P = 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy. CONCLUSIONS: The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re-epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.

Adolescent↗
PubMed1996

Parvovirus B19 in anemic liver transplant recipients.

Five hundred thirty-three liver transplant recipients were seen for follow-up care over a 6-month period. Of these, 23 (4.3%) had a hemoglobin level of < or = 9 g/dl, with 19 being eligible for inclusion in this study. The median hemoglobin level was 8.7 g/dl. Two patients had iron-deficiency anemia. All of the patients were on therapeutic drugs which can suppress erythropoiesis or shorten the lifespan of mature erythrocytes. Six patients (31.6%) were viremic for human parvovirus B19 but none was B19 immunoglobulin M seropositive. Two patients were immunoglobulin M seropositive for cytomegalovirus. The patients with circulating B19 DNA were not easily distinguished from those without the virus by their laboratory results. The absence of reticulocyte counts for these patients contributed to this inability to differentiate B19 from other causes of anemia, particularly drug myelotoxicity. The high likelihood of making a specific diagnosis with the increasing availability of PCR should spur the search for this virus in the liver transplant population.

Adult↗
PubMed1996

Comparison of a modified DNA hybridization assay with standard culture enrichment for detecting group B streptococci in obstetric patients.

Infection with group B streptococcus (GBS) results in 12,000 to 15,000 cases of neonatal sepsis annually in the United States. GBS is transmitted vertically in up to 70% of infants born to colonized women. Early-onset GBS disease (septicemia, pneumonia, or meningitis occurring within 7 days of life) has a mortality rate of up to 50%, with permanent neurologic sequelae occurring in 15 to 50% of infants surviving meningeal infection. Because of the fulminant nature of neonatal infection, it would be useful to have a rapid assay for determining the GBS status of laboring women. This study illustrated how a commercially available DNA probe-based test was modified to achieve this goal. Modifications included the use of mixed cultures rather than pure isolates for detecting GBS, along with a shorter culture enrichment time and a sample concentration step. To this end, vaginal and rectal swabs from 402 pregnant women during their third trimester were cocultured and tested for GBS rRNA. The 8-h enrichment protocol resulted in an assay with a sensitivity of 95% and specificity of 98%, while the 3-h enrichment protocol revealed a sensitivity of 73% and specificity of 99%. In summary, GBS was detected in the majority of colonized women in less than 4 h. This study illustrated the usefulness of the approach in identifying the most heavily colonized women, who are at the highest risk of transmitting GBS to their neonates. The modified test would have a significant impact on both the medical management and antibiotic therapy for these women and their newborns.

Bacteriological Techniques↗
PubMed1996

Effectiveness of individual and dyadic training protocols: the influence of trainee interaction anxiety.

The present study focuses on the consequences of the social dynamics that are created whenever two or more individuals are brought together for the purpose of training. An investigation of the role of individual differences in interaction anxiety on training outcomes demonstrated that the comparative effectiveness of dyadic versus individual protocols for computer-based training is moderate by trainees' level of interaction anxiety. Specifically, assignment to a dyadic protocol adversely affected the performance of high-interaction-anxiety participants but appeared to be advantageous for low-interaction-anxiety participants. Implications are discussed for changing the design and implementation of computer-based protocols for training groups and individuals in military and industrial training centers.

Adult↗
PubMed1995

Adult respiratory papillomatosis: human papillomavirus type and viral coinfections as predictors of prognosis.

Pathologic material and the records of 29 patients with laryngeal papillomatosis were reviewed. The relationship between the type of human papillomavirus (HPV) and the presence of viral coinfections was correlated with clinical outcome. Using polymerase chain reaction, paraffin-embedded specimens were analyzed for the presence of HPV, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV). The HPV type could be identified in 24 patients' specimens. Twenty-one patients were infected with HPV type 6. The other 3 were infected with HPV type 11 or 16. Three patients developed squamous cell carcinoma, of whom 2 had HPV type 11 or 16. We found HSV, EBV, and CMV in 50%, 12.5%, and 0% of specimens, respectively. An aggressive clinical course was observed in 17 patients. Evidence of coinfection with other viruses was identified in 11 (65%) of these patients. In contrast, a benign clinical course was observed in 7 patients, of whom 2 (29%) had viral coinfections. We conclude that the HPV type and the presence of viral coinfections may be predictive of an aggressive clinical course.

Adult↗
PubMed1994

Protective role of manganese superoxide dismutase against cigarette smoke-induced cytotoxicity.

Free-radical-induced oxidative damage has been implicated as an important mechanism responsible for the toxicity of both active and passive smoking. Cigarette smoke contains short- and long-lived radicals and can stimulate cellular production of highly reactive oxygen species. One of the antioxidant enzymes that is protective against reactive oxygen-induced damage is manganese superoxide dismutase (MnSOD), which is located in the mitochondria of mammalian cells. The present study was conducted to examine the role of oxidative damage in cigarette smoke toxicity. A mouse fibroblast cell line (C3H10T1/2) and its MnSOD-transfected, enzymatically active clone, R2 cells, which possessed about five-fold greater MnSOD activity, were used to test the cytotoxicity of condensates from mainstream (MS-CSC) and sidestream (SS-CSC) cigarette smoke. Growth and respiration studies of the two test cell lines showed that the R2 cells grew to a higher cell density and exhibited greater oxygen uptake than the parent cells under normal growth conditions. Both smoke condensates were cytotoxic to test cells, but SS-CSC exhibited slightly greater toxicity, and R2 cells were significantly less susceptible to SS-CSC toxicity than the parent cells. SS-CSC caused a slightly greater inhibition of respiratory activity in parent cells than in R2 cells. These results suggest a significant contribution of oxidative damage in SS-CSC cytotoxicity.

Animals↗
PubMed1994

Recurrent and de novo giant cell hepatitis after orthotopic liver transplantation.

This study examines the clinical and pathologic course of seven patients who developed giant cell hepatitis (GCH) after liver transplantation. Five of these patients also had GCH as their native liver disease and experienced a particularly aggressive course because of recurrent disease, beginning 1-21 months after transplantation. Two died and another two required hepatic retransplantation because of recurrent GCH; one of them had GCH recurrence in a second liver allograft. A remaining patient with recurrent GCH is alive 6 years after transplantation. Follow-up of the two patients who developed de novo GCH between 8 and 24 months after hepatic transplantation showed active micronodular cirrhosis in one and persistent giant cell transformation in the other at 4 years. All of the patients were serologically negative for hepatitis C virus, hepatitis B virus, and human immunodeficiency virus before transplantation. One patient became positive for hepatitis C virus after transplantation. Two patients had an associated autoimmune syndrome, which could have been accounted for by the GCH. None had a history of drug exposure. Interestingly, human papilloma virus (HPV) type 6 was detected by PCR analysis of liver tissues with GCH from one of three cases before and three of four cases after transplantation. This small series shows that GCH occurs in liver allografts, but it is uncommon. Documentation of recurrent disease in five of seven patients suggests that GCH in a subgroup of patients may be related to a transmissible agent, or that a particular recipient may injure livers in a way that elicits a giant cell reaction.

Adult↗
PubMed1994

PCR identification of four medically important Candida species by using a single primer pair.

A single pair of primers was used in a PCR assay to amplify and identify the DNAs from four medically important Candida species: C. albicans, C. parapsilosis, C. tropicalis, and C. (Torulopsis) glabrata. The report describes the first successful amplification of a chitin synthase-specific fragment from the four Candida species responsible for more than 90% of all cases of neonatal candidemia. The primer pair sequence was based on that from the C. albicans chitin synthase gene, CHS1 (J. Au-Young and P.W. Robbins, Mol. Microbiol. 4:197-207, 1990). Each of the four amplified products is a single band of a different size. The DNA sequence of each PCR product was determined, and four species-specific probes were synthesized. The DNAs from as few as 10 organisms in 100 microliters of plasma could be detected after amplification and Southern blot analysis. In a retrospective study of 27 paired blood samples from 16 patients with culture-proven candidemia, PCR analysis was successful at detecting and correctly identifying to the species level 26 of the 27 Candida isolates. The speed and accuracy of this PCR-based technology make it a very powerful tool for detecting and diagnosing candidemia. Implementation of this assay for analyzing blood samples should result in the more timely treatment of neonatal candidemia, thereby reducing morbidity and mortality.

Base Sequence↗
PubMed1993

Abnormal cervical cytology following large loop excision of the transformation zone: a case controlled study.

OBJECTIVES: To determine factors that may predict cytological outcome at 6 months following large loop excision of transformation zone (LLETZ) for cervical intra epithelial neoplasia (CIN) and to investigate the outcome in women with continuing cytological abnormality. DESIGN: Case controlled retrospective study. SETTING: Dudley Road Hospital, Birmingham and Midland Hospital for Women. SUBJECTS: Fifty-eight women with abnormal follow up cytology and a control group of 116 women. MAIN OUTCOME MEASURES: The relation between pretreatment and treatment factors and cytological outcome, and the relation between cytology and histology in women who had biopsies for persistent abnormal cytology. RESULTS: Univariate and stepwise logistic regression analysis showed that the number of sectors of atypical transformation zone (lesion size) and the excision margin status of the large loop excision specimen are of prognostic importance for the prediction of cytological abnormality at the 6 month follow up visit. Sixteen women have undergone further cervical biopsy. Of the five cases of persistent CIN, four had cytological changes showing moderate or severe dyskaryosis. Of the 11 women with koilocytosis or normal histology, 10 had mild dyskaryosis or borderline changes on their follow up cytology. CONCLUSION: Lesion size and excision margin status are important correlates of follow up cytology when treating patients for CIN with LLETZ. All women with abnormal cervical cytology at follow up should undergo colposcopic assessment. Excision biopsy is indicated if follow up cytology shows moderate or severe dyskaryosis, especially if still present 12 months after treatment.

Age Factors↗
PubMed1993

Colposcopy of the normal transformation zone.

To recognize the typical transformation zone, the colposcopist must first be familiar with the normal appearance of other parts of the cervix. These can be summarized as follows: original squamous epithelium, original columnar epithelium, squamo-columnar junction, metaplasia, and the congenital transformation zone.

Cervix Uteri↗