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Biomedical subjects

J C Reynolds

Publications and source records attributed to J C Reynolds.

At least 73 records · Page 4Linked to original sources

Differences in body composition of black and white girls.

Adults have racial differences in body composition that may modulate risks resulting from obesity. Although black and white children have been shown previously to have differences in bone mineral density and subcutaneous body fat, differences in visceral adipose tissue have not been evaluated. We studied 20 black and 20 white normal-weight girls aged 7-10 y, who were matched for weight, body mass index (BMI), bone age, chronological age, Tanner breast stage, and socioeconomic status. Each underwent anthropometric measurements, bioelectrical impedance analysis, dual-energy X-ray absorptiometry (DXA), and abdominal magnetic resonance imaging (MRI) for determination of total (TAT), visceral (VAT), and subcutaneous (SAT) adipose tissue. Serum lipids and fasting and 2-h oral-glucose-tolerance test (OGTT) glucose and insulin concentrations were also measured. There were no differences between groups in absolute waist circumference or waist-to-hip ratio, but waist-to-thigh ratio was smaller in black than in white girls. Black girls had greater bone mineral density and less TAT, VAT, and SAT than whites. VAT was not significantly correlated with any measure of insulin, or with serum lipids. However, both basal and 2-h OGTT serum insulin were significantly correlated with SAT as assessed by MRI in black girls (r2 = 0.46 for basal insulin, P = 0.001: r2 = 0.31 for 2-h insulin, P = 0.01) but not in white girls (r2 < 0.05, for basal and 2-h insulin, NS). We conclude that there are significant racial differences in body composition and differences in the strength of association between abdominal adipose tissue depots and insulin sensitivity in black and white girls.

Abdomen↗

Diethylcarbamazine-induced reversal of early lymphatic dysfunction in a patient with bancroftian filariasis: assessment with use of lymphoscintigraphy.

Exposure of expatriates to the infective larvae of Wuchereria bancrofti can result in the early development of signs of lymphatic obstruction. The findings on the clinical presentation of expatriates are distinct from the chronic pathological findings seen among the native population and are similar to the findings in experimentally infected persons. We report the case of a Peace Corps volunteer who developed acute lymphatic dysfunction within 3 months of arriving in an area that was endemic for filariasis. The diagnosis was established clinically and by demonstrating the presence of antibodies to recombinant proteins specific for patients with lymphatic filariasis. Lymphatic flow was markedly abnormal when assessed with use of 99mTc-lymphoscintigraphy. Treatment with diethylcarbamazine reversed both the physical and lymphoscintigraphic abnormalities.

Adult↗

The effect of Cushing's disease on bone mineral density, body composition, growth, and puberty: a report of an identical adolescent twin pair.

As endogenous Cushing's syndrome (CS) in children occurs during a critical developmental period, when the majority of peak bone mass is acquired, we hypothesized that children with CS might be at an increased risk of osteoporosis. To determine the effects of CS on bone density, bone metabolism, and growth, we studied a 15-yr-old female identical twin pair, one of whom had CS (twin A), and the other of whom was healthy (twin B). Before therapy for CS, twin A showed a severe loss of bone mineral density [BMD; -3.2SD at the lumbar spine (LS)] compared to twin B (-0.1 SD), which in twin A was associated with low serum osteocalcin levels and urinary pyridinium cross-link excretion. Cure of CS in twin A led to a marked increase in these bone markers, suggesting a state of active bone remodeling. After 27 months of follow-up, even though twin A's BMD improved significantly, it still remained abnormal [-1.9 SD at LS compared with that of twin B (0 SD)], suggesting that twin A continued to be at increased long term risk of osteoporosis. In addition, as a consequence of CS, twin A's final height was 21 cm less than that of her identical twin. We recommend that all children with CS should have BMD monitored after treatment to determine the long term risk of osteoporosis.

Adolescent↗

False-positive iodine-131 whole-body scans due to cholecystitis and sebaceous cyst.

False-positive whole-body 131I scans are not frequent but have serious consequences in the management of patients with thyroid cancer. They can be classified in four main groups: elimination of iodine in body fluids, infection or inflammation, cysts or transudates and nonthyroid tumors. We report on two patients with false-positive post-therapy 131I scans. The first patient had uptake projected in the right pelvic area which was later proven to be a large gluteal sebaceous cyst. The second patient had uptake in the gallbladder area that did not disappear after 131I treatment; she underwent exploratory laparotomy which revealed extensive chronic cholecystitis. These cases illustrate two new causes of false-positive 131I whole-body scans (sebaceous cyst and cholecystitis), which highlights two mechanisms (elimination in body fluid and inflammation).

Adenocarcinoma, Follicular↗

Risk factors for squamous cell carcinoma of the oesophagus.

Cancer of the oesophagus has great diversity in geographical distribution and incidence. The rate of oesophageal cancer has been increasing in some areas and the reasons for this are not clear. This review outlines fascinating epidemiological aspects and the risk factor for squamous cell carcinoma of the oesophagus. While in the Western world the effects of alcohol and tobacco are substantial preconditions, worldwide other factors, such as diet, nutritional deficiencies, environmental exposure and infectious agents (especially papillomavirus and fungi), play a significant role. Chronic irritation of the oesophagus appears to participate in the process of carcinogenesis, particularly in patients with thermal and/or mechanical injury, achalasia, oesophageal diverticulum, chronic lye stricture, radiation therapy, injection sclerotherapy and gastric resection before the appearance of oesophageal tumour. The association of Plummer-Vinson syndrome, coeliac disease, tylosis and scleroderma with oesophageal cancer has also been reviewed.

Carcinoma, Squamous Cell↗

Diagnostic imaging in patients with paragangliomas. Computed tomography, magnetic resonance and MIBG scintigraphy comparison.

OBJECTIVE: We compared iodine-131 metaiodobenzylguanidine (MIBG), computed tomography (CT) and magnetic resonance (MR) imaging studies in 40 patients with suspected or proven paragangliomas. PATIENTS: 21 patients were studied during the initial evaluation, while 19 were evaluated after surgery for paragangliomas. Furthermore, in 18 patients with benign (n = 10) or malignant (n = 8) tumors, MIBG uptake, MR signal intensity ratios (SIR) and CT parameters were analyzed. RESULTS: In patients studied during the initial evaluation, CT and MR had a significant (p < 0.05) higher diagnostic sensitivity (100% for both) compared to MIBG (82%); conversely, MIBG showed a higher specificity (100%) compared to CT and MR (50% for both); the accuracy of MIBG (86%), CT and MR (91% for both) were similar. In patients evaluated after surgery, MIBG and MR had slightly better sensitivity (85% for both) compared to CT (77%). MIBG showed again better specificity (100%) than CT and MR (83% for both); the accuracy of MIBG, MR and CT were respectively 90%, 84% and 79%. While no significant differences were observed in MR SIR and CT findings between benign and malignant tumors, MIBG uptake was significantly higher in malignant compared to benign lesions (p < 0.03). CONCLUSIONS: Our results suggest that CT and MR are particularly useful in the initial evaluation of patients with suspected paragangliomas. MIBG should be recommended during the post-surgical follow-up of such patients since recurrent, malignant or extra-adrenal disease frequently occur. Finally, while MR SIR and CT features are not able to distinguish malignant paragangliomas from benign tumors, MIBG uptake is higher in malignant lesions compared to benign tumors providing a diagnostic criterion to differentiate these lesions.

3-Iodobenzylguanidine↗

Radioimmunotherapy of interleukin-2R alpha-expressing adult T-cell leukemia with Yttrium-90-labeled anti-Tac.

Adult T-cell leukemia (ATL) is a malignancy of mature lymphocytes caused by the retrovirus human T-cell lymphotropic virus-I. It is an aggressive leukemia with a median survival time of 9 months; no chemotherapy regimen appears successful in inducing long-term disease-free survival. The scientific basis of the present study is that ATL cells express high-affinity interleukin-2 receptors identified by the anti-Tac monoclonal antibody, whereas normal resting cells do not. To exploit this difference, we administered anti-Tac armed with Yttrium-90 (90Y) to 18 patients with ATL initially (first 9 patients) in a phase I dose-escalation trial and subsequently (second group of 9 patients) in a phase II trial involving a uniform 10-mCi dose of 90Y-labeled anti-Tac. Patients undergoing a remission were permitted to receive up to eight additional doses. At the 5- to 15-mCi doses used, 9 of 16 evaluable patients responded to 90Y anti-Tac with a partial (7 patients) or complete (2 patients) remission. The responses observed represent improved efficacy in terms of length of remission when compared with previous results with unmodified anti-Tac. Clinically meaningful (> or = grade 3) toxicity was largely limited to the hematopoietic system. In conclusion, radioimmunotherapy with 90Y anti-Tac directed toward the IL-2R expressed on ATL cells may provide a useful approach for treatment of this aggressive malignancy.

Adult↗

Quantitative endoscopy: precise computerized measurement of metaplastic epithelial surface area in Barrett's esophagus.

BACKGROUND/AIMS: The inability to precisely measure the area of Barrett's metaplasia has impaired the study of its natural history and response to therapy. This study used a novel computer program that creates two-dimensional maps of the esophagus allowing for calculation of the area of Barrett's metaplasia. METHODS: Endoscopic photographs of Barrett's models and patients were obtained by independent endoscopists. The program transformed the photographs into maps, and the area of Barrett's metaplasia was calculated. RESULTS: Using models, calculated areas correlated with actual areas (r = 0.96) with an overall error of 5.2%. Color, size, shape, diameter of the model, or endoscopist's experience did not affect the accuracy. Accuracy did improve by decreasing the interval between photographs from 4 cm (10.0% error) to 2 cm (4.8% error). In patients, area calculations from maps created by independent technicians correlated precisely (r = 0.99) at 1-cm (n = 22) and 2-cm (n = 40) intervals. Independent endoscopists correlated precisely in producing photographs for map construction (r = 0.99; n = 20). CONCLUSIONS: This novel computer technology produces two-dimensional maps of Barrett's metaplasia that can be used to accurately calculate area. Minimal interobserver variability in obtaining photographs is found.

Adult↗

Amelioration of intestinal dysmotility and stasis by octreotide early after small-bowel autotransplantation in dogs.

BACKGROUND: Intestinal dysmotility and stasis after intestinal transplantation are considered to promote bacterial overgrowth and translocation. Two prokinetic agents, KW5139 (13-leu-motilin) and the somatostatin analogue octreotide acetate, were studied to determine whether they can ameliorate intestinal dysmotility during the early postoperative period. MATERIALS AND METHODS: Motility was recorded by multiple extraluminal strain-gauge transducers in 6 dogs on postoperative days 1, 3, 7, and 14. A barium meal study was performed with a separate group of 8 dogs on postoperative days 3 and 7. RESULTS: The agent KW5139 induced brief, weak contractions in the graft and had little effect on the dilated bowel; however, octreotide induced motor activity that propelled accumulated intestinal contents into the colon and reduced dilation of the transplanted bowel. CONCLUSION: Octreotide, but not KW5139, ameliorates intestinal dysmotility associated with bowel autotransplantation during the early postoperative period. Short-term administration of octreotide may be useful for the treatment of dysmotility following intestinal transplantation.

Animals↗

Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan.

Seventeen patients with papillary thyroid cancer whose serum thyroglobulin (Tg) levels were elevated when hypothyroid, but whose diagnostic whole body scans were negative, were treated with 150-300 mCi 131I. All patients had total thyroidectomy and 131I ablation for thyroid remnants. Before the study, 9 patients had 131I therapy for tumor recurrence and/or metastases, and 5 patients had excisions of nonfunctioning metastasis. Radiological studies did not reveal evidence of metastases. In the initial evaluation, Tg levels ranged from 8-480 ng/mL (24 pmol/L to 1.5 nmol/L), and posttherapy whole body scans (RxWBS) revealed undiagnosed local recurrence and/or metastases in 16 of 17 patients. Follow-up from 6 months to 5 yr is available in 16 patients. RxWBS after a second treatment was positive in 8 of 13 patients, and after a third treatment in 5 of 5 patients, although in 3 cases, uptake in distant metastasis had disappeared. In 8 patients, Tg fell to 5 ng/mL or less. In 1 patient, RxWBS became negative, but Tg remained elevated; subsequent treatment revealed local and mediastinal uptake, but previous lung uptake had disappeared. In 8 patients, RxWBS remains positive, and elevated Tg persists. A total of 35 RxWBS were performed; 29 were positive. Follow-up Tg concentrations decreased in 81% of patients after the first treatment, in 90% after the second treatment, and in 100% of the patients after the third treatment. Tg (mean +/- SE) decreased from 74 +/- 33 ng/mL in the first evaluation to 62 +/- 32 ng/mL in the second study and 32 +/- 20 ng/mL in the third study. The therapeutic effectiveness of 131I treatment in patients with elevated Tg and negative diagnostic whole body scans is indicated by the conversion to negative RxWBS, the statistically significant decrease in the mean Tg level, and the reduction of serum Tg to 5 ng/mL or less in 50% of patients. Further experience with this therapeutic approach is required to evaluate its effectiveness in improving prognosis and survival.

Adult↗

Osteoporosis is a toxic effect of long-term etretinate therapy.

BACKGROUND AND DESIGN: Osteoporosis has been observed with chronic hypervitaminosis A but has not been established as a toxic effect of synthetic retinoid therapy in humans. This cross-sectional study was designed to assess bone mineral density (BMD) during long-term therapy with the retinoids etretinate or isotretinoin. Twenty-four patients were evaluated for osteoporosis with the standard techniques: single- and dual-photon absorptiometry. They received 50 g or more of etretinate (15 patients) or isotretinoin (nine patients) for 2 years or longer for the treatment of skin disease (ichthyosis [nine patients], Darier's disease [six patients], xeroderma pigmentosum [four patients], skin cancer [three patients], or psoriasis [two patients]). In each of the two treatment groups, BMDs (measured in grams per square centimeter) were measured at five standard sites (ie, lumbar spine, femoral neck, trochanter, Ward's triangle, and radius) and evaluated against a standardized database to control for age, sex, and weight. In addition, for each measurement site, BMDs (controlled for age, sex, and weight) were compared between the two groups, as a direct control for each other. OBSERVATIONS: Compared with those of the age-, sex-, and weight-matched controls, the BMD values of the etretinate group were significantly decreased at four of the five measurement sites: femoral neck (90.6%, P = .0001), Ward's triangle (87.8%, P = .0001), trochanter (87.8%, P = .0012), and radius (85.0%, P = .039). In contrast, the BMDs in the isotretinoin group did not differ from control values except for an elevation at the lumbar spine (P = .039). When the two groups were compared, the mean BMDs were significantly lower in the etretinate group when measured at the lumbar spine, trochanter, and radius (P < .05). CONCLUSIONS: This study identified osteoporosis in patients who received long-term therapy with etretinate but not isotretinoin. Prospective studies of BMD would be useful to further define retinoid-associated osteoporosis.

Adult↗

Individualized acute treatment strategies for gastroesophageal reflux disease.

Although gastroesophageal reflux disease is among the most common disorders seen by gastroenterologists, the wide variation in both its symptoms and severity has led to a lack of consensus about the most appropriate practical approach to treatment of patients with acute symptoms. This review considers the efficacy of the most widely used pharmacologic agents in the acute treatment of gastroesophageal reflux disease: H2-receptor antagonists, proton-pump inhibitors, and prokinetic agents. Possible treatment strategies in which they may be used are discussed and it is proposed that individualized treatment strategies should be developed based on symptoms and severity of disease. Emphasis is placed on the fact that, given the wide variety of effective agents available, the use of the same agent in every patient, regardless of their symptoms, is a most inappropriate approach. A stepwise approach to therapy utilizing a number of drug classes is discussed and the rationale for and appropriate use of both a 'step-up' and 'step-down' approach is considered.

Anti-Ulcer Agents↗

Localization and inhibitory actions of galanin at the feline lower esophageal sphincter.

Intrinsic reflexes of the lower esophageal sphincter (LES) are mediated by specific arrangements of excitatory and inhibitory nerves. We have previously described an excitatory reflex at the feline LES mediated by a bombesin-like peptide (BN) which causes release of substance P (SP) to directly contract the LES. Galanin is a neurotransmitter in the enteric nervous system which colocalizes in neurons containing vasoactive intestinal peptide (VIP). The aims of this study were to determine: (1) the distribution of galanin at the feline LES; (2) the effect of galanin on basal LES tone; (3) the effect of galanin on agonist-induced LES contractions by BN, SP and bethanechol; and (4) the effect of galanin on LES relaxation induced by esophageal distension and exogenous VIP. Galanin-like immunoreactivity (galanin-LI) was localized in neurons that were widely distributed throughout the LES and adjacent organs. Galanin-LI was most abundant in the circular muscle, muscularis mucosa and myenteric plexus of the LES. In anesthetized cats, intra-arterial galanin had no effect on basal LES pressure in a dose range of 10(-11) to 10(-6) g/kg. Galanin (5.10(-7) g/kg) reduced the LES contractile response to SP by 65 +/- 8% (P = 0.0001). This galanin-mediated inhibition of SP was not blocked by tetrodotoxin. Galanin similarly decreased the LES contractile response to BN (63 +/- 7%, P = 0.005) and bethanechol (55 +/- 17%, P = 0.012). Galanin had no effect on the LES relaxation induced by esophageal distension or exogenous VIP. We conclude: (1) galanin-LI is present in neurons at the feline LES; (2) galanin has no effect on basal sphincter tone, but inhibits contractions of the LES by both direct and indirect agonists; and (3) galanin does not effect the LES relaxation induced by esophageal distension or VIP.

Animals↗

Immunohistochemical study of enteric nervous system after small bowel transplantation in humans.

The neurohormonal structures of two human intestines removed due to rejection 22 months and eight months after intestinal transplantation were studied by an indirect immunohistochemical method and compared with normal ileum. The distribution and density of neurons immunoreactive for tyrosine hydroxylase, substance P, calcitonin gene-related peptide, neuropeptide Y, vasoactive intestinal peptide, galanin, gastrin-releasing peptide, L-enkephalin, and somatostatin were examined. Mucosal endocrine cells immunoreactive for somatostatin, peptide YY, and glucagon were also examined. Extrinsic adrenergic fibers and perivascular fibers were absent in all intestinal layers of the failed grafts. The distribution of intrinsic neurons was unchanged; however, the density was decreased by one rank. Distribution of endocrine cells of the first graft was similar to the normal. Extrinsic fibers were not detected by immunohistochemistry in human small intestinal grafts following long-term survival and eventual rejection, while the immunohistochemical expression of intrinsic neural and endocrine transmitters were well preserved.

Adult↗