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Biomedical subjects

J G Armstrong

Publications and source records attributed to J G Armstrong.

At least 73 records · Page 4Linked to original sources
PubMed1990

The use of a prosthetic tissue expander to displace bowel from a brachytherapy implant site.

We describe the use of a prosthetic maneuver to displace bowel from an implant site. The patient presented with a recurrent low grade fibrosarcoma which was grossly excised with positive microscopic margins in the right paravertebral area. For this reason we performed an Iridium-192 implant using afterloading catheters. Because of several dense adhesions, it was not possible to mobilize an omental sling over the implant site. To prevent the small bowel from lying on the catheters, we inserted a prosthetic breast tissue expander. This was expanded with saline and bacitracin solution and placed in the tumor bed overlying the catheters, thereby displacing the small bowel away from the sources. A postoperative CT scan with gastrograffin demonstrated that this procedure was effective. There were no complications. We conclude that such devices are suitable for use under these circumstances and can achieve the objective of decreasing the dose of radiation to the small bowel.

Abdominal Neoplasms↗
PubMed1990

Combined modality therapy of extrahepatic biliary system cancer.

From January 1985 to December 1988, 10 patients with local/regional extrahepatic biliary system cancer (gallbladder: 2, Klatskin: 4, common bile duct: 4) underwent combined modality therapy. Laparotomy and biopsy or subtotal resection were performed in six patients and endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiogram, and biliary drainage in four patients. Patients initially received 5000 cGy to the tumor bed and primary nodal area. Eight received an additional 1500 cGy boost to the tumor bed. Chemotherapy (5-FU/mitomycin-C) was delivered at the beginning of each radiation treatment course. Four patients received an additional 1-4 cycles of maintenance chemotherapy and six received a boost with brachytherapy. The mean survival was 32 months and the median survival was 16 months. Five patients are currently NED at 16, 17, 17, 48, and 52 months. The overall 3-year actuarial survival was 50%. The cumulative incidence of failure as a component of failure was local/regional: 50%, abdominal: 40%, and distant: 10%. Of the five patients who developed failure, all developed a component of local/regional failure. Our data show that this approach is feasible and offers similar results to those reported in the literature. However, further follow-up will be needed to determine if this combined modality approach offers improved local control and survival rates compared with surgery or biliary bypass/drainage alone.

Biliary Tract Neoplasms↗
PubMed1990

Characteristics of patients with multiple personality and dissociative disorders on psychological testing.

We describe a new psychological testing procedure used on a consecutive series of 14 patients with multiple personality and dissociative disorders who met DSM-III-R and research criteria for dissociative disorders. Once dissociative phenomena were accounted for in testing, most patients displayed response patterns markedly different from those of schizophrenic and borderline patients. Patients showed striking variability on cognitive and projective tests, often related to posttraumatic intrusions. Rorschach protocols showed unusual thinking accompanied by psychological complexity and highly developed self-observing capacity. In contrast to classical conceptualizations about these patients, most subjects had personality profiles that were intellectualized, obsessive, and introversive, not histrionic or labile.

Adaptation, Psychological↗
PubMed1989

Radiation therapy for medically inoperable stage I and II non-small cell lung cancer.

The published results of primary radiation therapy for early stage NSCLC, indicate that it is a reasonable alternative in patients with medical contraindications or who refuse surgery, resulting in acceptable morbidity, local control, and survival rates. There is no conclusive evidence that EMI is of benefit. Consequently treatment with involved field alone, may be considered when there is no evidence of hilar involvement, or when it is necessary to limit the volume of lung tissue irradiated. Although the data are not conclusive, there is evidence to suggest that the total dose of radiation delivered to the primary should be sufficient to eradicate gross disease (60 Gy or higher). Such does result in high response rates particularly for T1 tumors. There is also an indication that complete responders have better survival than other patients, suggesting that radiotherapeutic strategies to enhance tumor eradication may improve survival.

Carcinoma, Non-Small-Cell Lung↗
PubMed1989

Streptococcus pyogenes pneumonia with abscess formation.

A 30-year-old female with mild asthma presented with high fever, hypotension, pleuritic chest pain, vomiting and diarrhea. Chest radiograph showed consolidation of the right upper lobe, and S. pyogenes was cultured from blood and sputum. Following initial rapid recovery the patient relapsed ten days after antibiotics were ceased, with rapid development of a large abscess cavity. Clinical improvement occurred following reinstitution of treatment including intravenous penicillin. Progressive radiological resolution eventuated during outpatient follow-up. This case demonstrates that S. pyogenes pneumonia may occur without an antecedent viral infection or major predisposing condition, cause rapid cavitation despite antiobiotic therapy and resolve satisfactorily with prolonged penicillin therapy.

Adult↗
PubMed1988

Spinal deformity and back surface asymmetry in idiopathic scoliosis.

Stereo radiography and stereotopography were used to record simultaneously the three-dimensional spinal and back surface shape of 141 patients with a clinical diagnosis of adolescent onset idiopathic scoliosis. Radiography confirmed 80 patients with single lateral curves (Cobb angle 5-87 degrees); 59 with double curves (Cobb angle 5-61 degrees), and two patients with triple curves. Orientation of each vertebra was measured by the lateral deviation from the spinal axis and the axial rotation. For each curve detected, the Cobb angle, the maximum deviation, the maximum axial rotation, and the sagittal plane curvature was measured. Topographic data were used to generate a profile of a cross-section through the back of each vertebral level. This section was characterized by its axial rotation, deviation of its midpoint from the spinal axis, and area symmetry about the midpoint. Maximum values of these measurements in the region of each radiographic scoliosis curve were noted. Regression and correlation analysis showed (for each curve) a high correlation of apical vertebral lateral deviation with back surface axial rotation (r = 0.79) and with vertebral axial rotation (r = 0.79). The back surface rotation was less than vertebral rotation in magnitude, however, by a mean factor of 0.55. The measurement of the back surface asymmetry that gave the highest correlation with the skeletal deformity was the axial rotation. Relationships between skeletal and surface measures were similar for curves in thoracic and lumbar regions and for patients with single and double curves. There is potential for clinical application of surface measurement techniques to prescription of orthoses and monitoring of changes due to progression or treatment.

Adolescent↗
PubMed1987

Nebulized fenoterol and i.v. aminophylline in acute severe asthma.

We investigated the bronchodilator effect of intravenous aminophylline given after a cumulative dose of nebulized fenoterol of 2.4 mg in 18 patients with acute severe asthma. The mean forced expiratory volume in 1 s (FEV1) +/- SD before treatment was 0.72 +/- 0.22 l. The mean improvement in FEV1 after fenoterol was 0.64 +/- 0.39 l (85% of total improvement) and after aminophylline 0.11 +/- 0.13 l (15% of total improvement). The improvement after aminophylline was statistically significant (p less than 0.01), though quantitatively small. Thirteen patients improved after aminophylline by less than 0.15 l, and in only five was the improvement 0.2-0.4 l. There was no significant change in heart rate and subjective tremor score with treatment, although observed tremor (0 = absent, 4 = maximum) increased from 0.4 +/- 0.6 to 1.3 +/- 1.0 after all treatment. For the majority of patients presenting with acute severe asthma, it is likely that high doses of nebulized beta-2 agonist alone will produce near maximal bronchodilation in the short term.

Acute Disease↗
PubMed1983

Nebulized fenoterol in severe asthma: determinants of the dose response.

We assessed the bronchodilator response to cumulative doses of nebulised fenoterol in 16 patients with severe asthma to determine (1) the magnitude of the bronchodilator response, (2) the factors determining this response, and (3) the dose producing maximum bronchodilation. To reflect the degree to which ventilatory function returned to normal, individual bronchodilator responses were assessed as the change in FEV1 (post-fenoterol FEV1 - initial FEV1) and expressed as a percentage of the predicted maximum response (predicted FEV1 - initial FEV1). The bronchodilator response was extremely varied (about 55% of predicted maximum in six patients, 40% in three patients, and 20% in seven patients), as was the dose producing maximal bronchodilation (1 mg in three patients, 2 mg in six patients, and 2.5 or 3 mg in seven patients). In individual patients the maximum response could be predicted by the response to the initial dose of fenoterol and by the duration of the episode of severe asthma. The maximum response was not predicted by the initial severity of obstruction or the patient's usual treatment.

Administration, Intranasal↗
PubMed1982

Mycobacterial cross-contamination of bronchoscopy specimens.

Bronchoscopy specimens from 3 patients investigated during 1 wk at a large teaching hospital were culture positive for the same serovar of Mycobacterium intracellulare. Review of laboratory records and patient data suggested that only the first patient examined was a genuine excretor of mycobacteria; the isolates from the other 2 patients were false positives caused by inadequate disinfection of part of the collection apparatus between use. The investigations confirm the suitability of glutaraldehyde as a rapid, highly effective antimycobacterial disinfectant and illustrate the value of serotyping when dealing with mycobacterial isolates of questionable significance.

Aged↗
PubMed1981

Nephrotoxicity of drugs.

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Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1976

Lung function in asymptomatic cigarette smokers--the single breath nitrogen test.

The modified single breath nitrogen (SBN) test and simple spirometry were used to study the lung function (LF) of 101 asymptomatic, cigarette smoking and 20 non-smoking men aged 18 to 39 years. Abnormal LF was demonstrated in 39% of smokers. An abnormal SBN test was found in 28% of the light and 56% of the heavy smokers but only 3% were spirometrically abnormal. Only one non-smoker had an abnormal SBN test. Closing volume and slope of the alveolar plateau, which are both measured from the SBN test, correlated poorly suggesting that the abnormality caused by smoking may differ among smokers. The SBN test is a simple test which is sensitive enough to detect LF abnormalities in young smokers. The significance of the detected abnormalities in relation to the development of chronic obstructive lung disease is not presently known.

Adolescent↗