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Biomedical subjects

J H Ellis

Publications and source records attributed to J H Ellis.

At least 37 records · Page 2Linked to original sources

Functional analysis of the T-cell-restricted protein tyrosine kinase Txk.

T lymphocytes express a range of tyrosine kinases that are involved in signalling processes driving cell activation, proliferation and differentation. Two tyrosine kinases expressed only in T cells, the Itk/Emt and Txk gene products, are members of the Tec family of kinases. The role of Tec kinases in cellular function is poorly understood, although a Tec kinase specific to B cells, Btk, is essential for B-cell development. To explore the contribution of the T-cell-specific Tec kinases to lymphocyte function, we have expressed human Txk in the baculovirus system and conducted the first characterization of its activity. We find that Txk exhibits a substrate preference in vitro quite distinct from that of the major T-cell kinases Lck and ZAP70, suggesting that Tec-family kinases might act on a distinct range of substrates. We also investigated the interactions of Txk with the cytoplasmic domains of the key signalling molecules CD3zeta, CD28 and CTLA4 and find that none of these are phosphorylated by Txk, nor are they ligands for the SH2 or SH3 domains of Txk. We conclude that it is unlikely that Txk has a role in the early signal transduction events associated with these key pathways controlling T-cell activation.

Abatacept↗

Iodinated contrast material in uroradiology. Choice of agent and management of complications.

Many conditions seen by urologists require imaging examinations with iodinated radiographic contrast material as a key part of the primary evaluation of the patient. A basic understanding of contrast media, risks of administration, choice of agents, and premedication regimens for high-risk patients, is beneficial in helping patients prepare for their examinations. Urologists may be the primary physicians administering contrast material or may be working with radiologists in the care of patients receiving contrast agents. Because contrast reactions may occur unexpectedly, even during examinations in which the agents are not given intravenously, urologists should be able to recognize and treat the various types of adverse reactions.

Adrenal Cortex Hormones↗

Local reactions after injection of iodinated contrast material: detection, management, and outcome.

RATIONALE AND OBJECTIVES: The authors assessed the frequency, sequelae, and risk factors of extravasation of intravenously administered iodinated contrast media. MATERIALS AND METHODS: All patients with local reactions after intravenous injection of contrast media between November 1994 and December 1996 were studied. Comparison was made with data obtained from a control group of 100 patients with no local reactions who underwent contrast material-enhanced computed tomography (CT). RESULTS: Local reactions were reported in 56 (0.25%) of 22,254 patients who received intravenous injections of iodinated contrast media. Fifty-one patients experienced extravasation, and five patients experienced local irritation in the absence of clinically detectable extravasation. Extravasation occurred during CT (n = 46), urography (n = 4), and venography (n = 1). Contrast material was nonionic in 37 cases and conventional ionic in 14 cases of extravasation. Extravasated volumes exceeded 30 mL in 22 patients and 100 mL in six patients. Forty-five (80%) of 56 patients with local reactions had complete resolution of symptoms within 24 hours. Only four patients had symptoms for more than 48 hours. No surgery was required. Compared with the control group, patients with extravasation were significantly more likely to have been injected with small-bore catheters (21 or 22 gauge) and to have been injected at low or high rates. CONCLUSION: Symptoms of contrast medium extravasation usually resolve quickly. In patients with extravasation, injections are more likely to have been performed with techniques that vary from normal practice.

Blister↗

Lupus nephritis: predictive value of conventional and Doppler US and comparison with serologic and biopsy parameters.

PURPOSE: To compare conventional and Doppler ultrasound (US) with clinical and biopsy parameters used to assess disease activity and outcome in lupus nephritis and to assess the predictive value of US. MATERIALS AND METHODS: Thirty-four patients with lupus nephritis prospectively underwent laboratory and US analysis at the time of renal biopsy. US parameters were renal length, relative echogenicity, and resistive index (RI). Laboratory parameters were serum creatinine level, urinary protein level, and serum markers of disease activity. Biopsy parameters were activity index, chronicity index, and assessment of the tubulointerstitium of the kidney. Follow-up data were obtained in all patients for at least 1 year. RESULTS: Ten patients with elevated RI (>0.70) had significantly (P <.05) higher chronicity indexes and creatinine levels than the 24 patients with a more normal RI. RI correlated significantly (P <.05) with creatinine level, chronicity index, and presence of interstitial disease. Only RI and chronicity index were statistically significant predictors of a poor renal outcome. Abnormalities at conventional US were not predictive of renal outcome. A normal RI predicted a better renal outcome whether or not creatinine level was elevated. CONCLUSION: Renal Doppler US may be of greatest clinical utility when its results are apparently discordant with renal functional assessment by allowing identification of patients with higher likelihood of subsequent improvement or worsening of renal status.

Adolescent↗

Liver metastases: early detection based on abnormal contrast material enhancement at dual-phase helical CT.

PURPOSE: To assess whether contrast material enhancement findings on computed tomographic (CT) scans are useful in determination of the risk for development of hepatic metastases. MATERIALS AND METHODS: Dual-phase helical CT scans were obtained in 80 patients with nonhepatic cancer and no hepatic metastases visible at CT. Attenuation was measured on scans obtained at 25 and 40 seconds. Peak liver attenuation was determined in all cases. Unenhanced scans were obtained in 35 patients. The ratio of liver attenuation at 25 and 40 seconds to peak liver attenuation, liver enhancement values at 25 and 40 seconds, and ratio of liver enhancement at 25 and 40 seconds to peak liver enhancement were determined. RESULTS: Liver metastases developed during 18-month follow-up in 22 patients. The 25- and 40-second liver enhancement values and the liver enhancement and attenuation ratios were higher in these patients than in those who did not develop metastases (P < .01). Enhancement values and ratios were more accurate than densitometric measurements for predicting development of metastases. Use of an optimal threshold (0.40 or greater) for the 40-second enhancement ratio resulted in a sensitivity of 75%, specificity of 96%, and overall accuracy of 89%. CONCLUSION: CT measurements may help in the prediction of risk for subsequent development of hepatic metastases.

Absorptiometry, Photon↗

Use of Doppler sonography for revealing hepatic artery stenosis in liver transplant recipients.

OBJECTIVE: The goal of our study was to evaluate the use of duplex Doppler sonography for revealing hepatic artery stenosis (HAS) in patients who have undergone liver transplantation. MATERIALS AND METHODS: Forty-six patients with spectral Doppler waveforms obtained from the hepatic artery and with subsequent arteriography were reviewed retrospectively. Arterial waveforms, resistive indexes (RIs), and systolic acceleration times (SATs) were evaluated by one reviewer who was unaware of the arteriographic findings. The mean interval between the two examinations was 2.8 days. Arteriograms that revealed a stenosis of greater than 50% were classified as abnormal. RESULTS: Of the 46 patients, 21 (46%) had a significant stenosis. Patients who had HAS had significantly (p < .05) prolonged SATs (0.08 +/- 0.03 sec versus 0.06 +/- 0.02 sec) and reduced RIs (0.49 +/- 0.05 versus 0.66 +/- 0.05) compared with patients who did not have HAS. Optimal thresholds for HAS detection were RIs less than 0.55 and SATs greater than 0.08 sec. HAS was found in 14 of 15 patients who had both abnormal RIs and SATs. Of the remaining 31 patients, 12 had abnormal values for RI or SAT. Of these 12 patients, three had HAS. Thus, 19 patients had normal RIs and SATs; however, four of these patients were found to have an arterial stenosis. In our 46 patients, abnormal values for both RI and SAT were 67% sensitive and 96% specific for stenosis. When at least one abnormal value was found on Doppler imaging, sensitivity and specificity for stenosis were 81% and 60%, respectively. CONCLUSION: Duplex Doppler imaging can noninvasively reveal HAS. Abnormal values for both RI and SAT proved to be a more accurate predictor of stenosis than either RI or SAT as independent parameters.

Adult↗

Helical CT evaluation of potential kidney donors: findings in 154 subjects.

OBJECTIVE: The purpose of our study was to assess renal helical CT (RHCT) as the primary imaging technique in the evaluation of potential kidney donors. SUBJECTS AND METHODS: Unenhanced and enhanced (3-mm collimation) RHCT was performed in 154 kidney donors using 125-150 ml of i.v. contrast material at an injection rate of 3 or 4 ml/sec and a pitch of 1.3-2. Scans were reconstructed at 1.5-mm intervals for a three-dimensional image. RHCT images were compared with the results of renal arteriography (RA) (50 subjects) and surgery (117 subjects). RESULTS: CT and surgical findings agreed in 95% of patients (111/117), with five cases of missed accessory arteries (all < 2 mm in diameter) and one case of a missed early division of the main artery. In the 50 subjects who underwent CT and RA, imaging revealed concordance in 96% of 100 kidneys. One small accessory artery was not detected by CT (origin from the common iliac artery). RA did not detect accessory arteries in three subjects. All 22 kidneys with early dividing main arteries (< 1.5 cm from the aortic origin) were identified by both RHCT and RA. Axial and three-dimensional CT images were complementary: five small accessory arteries were seen well only on the axial sections, whereas four early dividing arteries and two cases of renal artery stenosis were prospectively identified only on the three-dimensional images. Twenty-five renal vein anomalies were detected only by CT. In the full series of 154 subjects, nonvascular renal findings included renal calculi (n = 11), cysts (n = 12), duplicated ureters (n = 6), horseshoe kidney (n = 1), and pelvic kidney (n = 1). CONCLUSION: RHCT can be the primary imaging technique in the assessment of potential kidney donors, reducing the number of examinations as well as the risk and cost of imaging in these subjects.

Adult↗

Sociological and anthropological factors related to the community management of tuberculosis in the Western Cape communities of Ravensmead and Uitsig.

OBJECTIVE: To determine the sociocultural understanding of tuberculosis among patients and their household members. DESIGN: Qualitative descriptive study. SETTING: Two adjacent Western Cape suburbs with a population of approximately 35,000, a tuberculosis incidence of > 1,000/100,000 and a surface area of 2.42 km2. SUBJECTS: Twenty-three adult patients on treatment for tuberculosis and their adult household members. INTERVENTIONS: None. METHODOLOGY: Consecutive selected adult tuberculosis patients and their household members were interviewed with an open-ended interview schedule. General household and community conditions and non-verbal responses were recorded. RESULTS: There were relatively affluent but also severely deprived households with severe overcrowding. Substance abuse was common. Patients had limited understanding and knowledge about health, hygiene and the cause of tuberculosis. There was a perception of both physical and social distance between patients and health care providers. All patients relied exclusively on the conventional biomedical curative approach of the medical system to deal with tuberculosis.

Adult↗

Interactions of CD80 and CD86 with CD28 and CTLA4.

CD80 and CD86 are cell surface glycoproteins expressed on a variety of professional APCs. They have attracted much attention due to their function as potent costimulators of T lymphocyte function through their interaction with CD28 and possibly CTLA4. Because inhibitors of this interaction may have therapeutic relevance in human autoimmune disease, we investigated the properties of linear peptides derived from conserved regions of CTLA4 and CD80 known to be essential for binding. None of these peptides were sufficient to bind ligand, nor did they act as potent competitive inhibitors. Conformationally constrained versions of the CTLA4 motif were also inactive. These results suggested that other parts of the proteins are important in determining binding, so a series of modified CD80 and CD86 molecules were constructed in an attempt to identify other binding determinants. Insertion of two residues between the two Ig domains of CD80 resulted in decreased affinity for CTLA4, but a similar mutation in CD86 was without effect. We also identified another asymmetry between CD80 and CD86 in that the V domain of CD86 but not that of CD80 is sufficient for CTLA4 binding. The CD86-V domain appears to have CTLA4 binding properties equivalent to that of intact CD86. These data illustrate a fundamental difference between these costimulatory molecules and suggest a mechanism by which they may be differentially recognized by receptors on the T cell surface.

Abatacept↗

Magnetic resonance imaging of the levator ani with anatomic correlation.

OBJECTIVE: To define in women the anatomy of the levator ani muscle visible on magnetic resonance imaging (MRI) so these muscles can be studied in women with prolapse or incontinence. METHODS: Multiplanar T1- and T2-weighted MRI was obtained of two female pelvic cadaver specimens, ages 25 and 33. One specimen was hemisected, with half sectioned in the axial plane and the other half in the coronal plane. The other specimen was sectioned in the coronal plane. Anatomic cross sections of these specimens were correlated with the cadaver MRI and MRI of living patients. One sagittal and two axial series of anatomic sections not imaged were also used for comparison. RESULTS: Serial sagittal and axial MRI demonstrates the pubovisceralis ("pubococcygeus") muscle as it originates from the pubic bone, passes alongside the urethra, vagina, and rectum, and then dorsal to the anorectum. Its muscle bulk, attachment to the distal half of the vagina, and insertion between the internal and external anal sphincters can be seen on axial views. The origin of the iliococcygeus muscle at the arcus tendineus levator ani is seen in axial and coronal images. Coronal and sagittal images demonstrate the relative thickness and medial position of the pubovisceralis muscle compared with the thin, diaphragm-like lateral iliococcygeus muscle. CONCLUSION: Magnetic resonance imaging of the cadaver pelvis demonstrates the detailed anatomy of the levator ani muscle. This is an important precursor to future research of the structure, bulk, and orientation of the levator ani in living women with prolapse.

Adult↗

Assessment of renal function with computed tomographic densitometry measurements.

RATIONALE AND OBJECTIVES: We assessed the relationship between multiple renal computed tomographic (CT) densitometry parameters and renal function. METHODS: Three hundred seventy-three patients underwent standardized helical CT of the abdomen. The ratio of mean attenuation in the renal cortex to mean attenuation in the aorta (KAR), the products of mean renal cortical attenuation with CT-estimated renal volume (KVP), and the patient's weight (KWP) were derived from scans obtained 90 sec (n = 373) and 30 sec (n = 108) after initiation of intravenous contrast material administration. These densitometry parameters were compared with renal function measured by serum level of creatinine and creatinine clearance (CrCl). RESULTS: Among the 373 patients in the study, we found statistically significant differences (p < .01) between the patients with normal renal function (CrCl > or = 60 ml/min, n = 300) and the patients with abnormal renal function (CrCl < 60 ml/min, n = 73) for the KAR, KVP, and KWP. The KAR was the parameter best correlated with CrCl and was an independent predictor of renal function from the patient's age, weight, and renal volume. Fifty-three patients with a KAR less than 1 had significantly worse renal function (CrCl = 60 +/- 21 ml/min) than the patients with a KAR greater than or equal to 1 (CrCl = 95 +/- 31 ml/min). Only 4% of patients with normal renal function had a KAR less than 1. A threshold value of KAR less than 1 had a sensitivity of 55%, a specificity of 96%, a positive predictive value of 75%, and a negative predictive value of 90% for predicting renal dysfunction. CT parameters obtained at 30 sec were less useful than parameters at 90 sec. CONCLUSION: In patients undergoing clinically requested CT scanning, renal densitometry analysis can be used to depict patients with normal renal function; however, it has a high false-negative rate in depicting patients with diminished renal function.

Absorptiometry, Photon↗

Potential renal donors: comparison of conventional imaging with helical CT.

PURPOSE: To assess helical computed tomography (CT) as a potential substitute for intravenous urography and renal angiography in the evaluation of living potential renal donors. MATERIALS AND METHODS: Helical CT was performed in 32 potential donors both before and after administration of contrast material. Scans were reconstructed at 1.5-mm intervals for three-dimensional reconstructions. Helical CT images were blindly compared with urograms (n = 32) and renal angiograms (n = 24). RESULTS: One small accessory artery was not depicted with helical CT, and angiography did not depict an accessory artery arising in proximity to the origin of the main renal artery. All eight kidneys with early dividing main arteries were identified with both helical CT and angiography. Three renal venous anomalies were depicted only with helical CT. Helical CT and urography equally depicted nonvascular findings. CONCLUSION: Renal helical CT is a suitable replacement for intravenous urography and angiography in the assessment of living renal donors.

Adult↗

Hepatic hemodynamic alterations after administration of oral CT contrast agents.

PURPOSE: To assess the effects of oral computed tomography (CT) contrast agents on hepatic hemodynamics with duplex Doppler ultrasound (US). MATERIALS AND METHODS: Thirty healthy subjects who fasted underwent duplex Doppler US of the hepatic artery and portal vein both before and after administration of oral CT contrast agents. Resistive indexes were determined for the hepatic arteries. Peak and mean velocity (centimeters per second) and mean diameter were calculated for the main portal vein. RESULTS: Statistically significant elevation of the resistive index (P < .01) of the hepatic arteries was observed after ingestion of oral CT contrast agents. Increase in the mean resistive index at 15 minutes was 12% in the proper hepatic arteries and 20% in the intrahepatic arteries. There was a postprandial increase in mean portal venous flow compared with baseline levels (1,110 mL/min +/- 210 vs 940 mL/min +/- 140) (P < .05). CONCLUSION: An elevation of hepatic artery resistance that is probably due to arterial vasoconstriction after ingestion of oral CT contrast agents can be observed with Doppler US. Hemodynamic changes in liver vasculature after ingestion of oral CT contrast agents may have as yet unknown implications for CT scanning of the liver.

Administration, Oral↗

Suspected obstructive pyelocaliectasis: Doppler ultrasonography compared with diuretic renal scintigraphy in proven cases.

OBJECTIVE: To compare Doppler ultrasonography with diuretic renal scintigraphy in the differentiation of obstructive from nonobstructive pyelocaliectasis. PATIENTS AND METHOD: The authors reviewed the findings of Doppler ultrasonography and diuretic renal scintigraphy performed over a 3-year period for 27 pyelocaliectatic kidneys (17 obstructed and 10 unobstructed) in 20 individuals ranging in age from 19 to 88 years. The kidneys were classified as "obstructed" or "unobstructed" on the basis of the resistive index as calculated from Doppler ultrasonographic results and as "obstructed", "unobstructed" or "indeterminate" on the basis of the clearance half-time determined from scintigraphic findings. RESULTS: On the basis of scintigraphy, the obstruction status was indeterminate in 12 of the 27 kidneys. The data were analysed for sensitivity and specificity in two ways, first by classifying the kidneys with indeterminate obstruction status as "obstructed, " and then by excluding them from the analysis altogether. In both situations, the differences in sensitivity and specificity between Doppler ultrasonography and scintigraphy were not statistically significant (chi 2 test, p > 0.05). When the kidneys with indeterminate obstruction status were included in the obstructed category, the sensitivity and specificity of Doppler ultrasonography were 94% and 90% respectively and of scintigraphy 100% and 70% respectively; when the kidneys with indeterminate obstruction status were excluded, the sensitivity and specificity of Doppler ultrasonography were 83% and 89% respectively and of scintigraphy 100% and 78% respectively. CONCLUSIONS: These results suggest that Doppler ultrasonography is comparable to diuretic renal scintigraphy in the work-up of potential obstructive pyelocaliectasis. Because grey-scale ultrasonography is usually performed before scintigraphy, a Doppler examination could be added at this stage, which might reduce the time necessary to establish the diagnosis.

Adult↗

Treatment of adverse reactions to radiographic contrast media in adults.

Prompt recognition and treatment can be invaluable in blunting an adverse response of a patient to radiographic contrast material and may prevent a reaction from becoming severe or even life-threatening. Radiologists and their staff should review treatment procedures regularly (at least annually) so that each staff in attendance can accomplish his or her role efficiently. Knowledge, training, and preparation are crucial in guaranteeing appropriate and aggressive therapy in the event of an adverse contrast-related event.

Anaphylaxis↗