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Biomedical subjects

J Hardy

Publications and source records attributed to J Hardy.

At least 505 records · Page 28Linked to original sources
PubMedDate not supplied

Transarterial coil embolization of the internal and external carotid and maxillary arteries for prevention of hemorrhage from guttural pouch mycosis in horses.

OBJECTIVES: To develop a transarterial coil embolization technique for occlusion of the internal carotid artery (ICA), external carotid artery (ECA), and maxillary arteries (MA) in normal horses and to evaluate this technique for prevention of hemorrhage in horses affected with guttural pouch mycosis. ANIMALS: Ten adult, normal horses and 4 horses with guttural pouch mycosis. METHODS: All horses had transarterial coil embolization of the rostral and caudal ICA, caudal MA, and rostral ECA. In 1 affected horse, an aberrant actively bleeding branch of the ECA was also occluded. Normal horses had a premortem angiogram, and were killed either at 1 or 2 weeks or 1, 2, or 3 months after the procedure. Specimens from the ICA, ECA and MA were evaluated by light microscopy. RESULTS: No surgical complications were observed, except 1 horse that developed laryngeal hemiplegia and 1 pilot horse that had embolization of the cerebral arterial circle. In normal horses, premortem angiography confirmed complete occlusion of all vessels, and coils were positioned as intended. All normal horses had partially maturing to mature, continuous thrombi occluding at the coils. In affected horses, no further episodes of epistaxis were observed. By day 60, all mycotic plaques had resolved without further treatment. Ophthalmic complications were not observed. CONCLUSION: Transarterial embolization provided a safe, rapid, and effective method for ICA, ECA, and MA occlusion in normal and affected horses. In affected horses, the technique was possible despite active bleeding, allowing adequate identification and occlusion of all sources of hemorrhage.

Angiography↗
PubMedDate not supplied

Use of an isolated joint model to detect early changes induced by intra-articular injection of paclitaxel-impregnated polymeric microspheres.

Paclitaxel is a chemotherapeutic agent that suppresses cellular proliferation and angiogenesis and has been effective in suppressing proliferative synovitis in animal models. Local joint delivery ofpaclitaxel is being pursued as a treatment for rheumatoid arthritis in humans, to avoid systematic toxicity of the drug. We used an extracorporeal, isolated metacarpophalangeal joint preparation that uniquely permitted the simultaneous evaluation of codependent hemodynamic, microvascular, and transsynovial flow responses of a joint. Specifically in this study, the isolated joint preparation provided quantitative assessment of vascular flow, transsynovial flow, and morphologic changes in response to intraarticular injection of paclitaxel (50 ng) in poly-(DL)-lactide co-glycolide 50:50 microspheres (50 microm diameter) to assess initial intra-articular biocompatibility. Control joints were isolated but not injected. Serial hemodynamic measurements, transsynovial fluid forces, synovial fluid analysis, synovial and capillary permeability, and oxygen metabolism were measured every 30 min during a subsequent 3-h isolation period. At termination, synovium and cartilage were harvested from bilateral metacarpophalangeal joints for histopathologic assessment. Intra-articular injection of this formulation of paclitaxel did not significantly affect hemodynamic parameters in the joint during this short-term study, and early joint inflammatory reaction was minimal. However, transsynovial fluid forces were significantly greater in treated joints as evidenced by greater synovial fluid flow, intra-articular pressure, transitional microvascular pressure, and permeability to fluid transport. Gross and histologic morphology of synovium and articular cartilage were normal in all isolated joints. In conclusion, this extracorporeal in vivo isolated joint model permitted investigation of the early changes in joint physiology induced by this microsphere formulation and dose ofpaclitaxel in joints and could provide a more physiologic and dynamic model for study of the pharmacokinetics of drug absorption following intra-articular administration. Due to the minimal inflammation and lack of evidence of gross or histologic change in the joint, this formulation of paclitaxel should be adequately biocompatible for use in an in vivo animal model for further study of its feasibility for human use.

Animals↗
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Arthrodesis of the distal interphalangeal joint in two horses using three parallel 5.5-mm cortical screws.

The distal interphalangeal joint was successfully arthrodesed in two horses using three parallel 5.5-mm cortical screws and an autogenous cancellous bone graft. The screws were directed from the palmar proximal border of the second phalanx dorso-distally across the joint space and into the third phalanx. The technique was first developed on a normal horse. The second horse, a clinical case, ruptured its deep digital flexor tendon with complete luxation of the distal interphalangeal joint. Bony fusion of the distal interphalangeal joint occurred in both horses, but both also had residual lameness at a walk. Twenty-one months after the arthrodesis procedure, the clinical patient died from complications related to a subsolar abscess in the operated limb.

Animals↗
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Colonic luminal pressure in horses with strangulating and nonstrangulating obstruction of the large colon.

Colonic luminal pressure (median, range) measured during ventral midline celiotomy in 69 horses with strangulating obstruction (SO) of the large colon (SO; > or = 270 degrees large colon volvulus; 27 cm H2O: 2 to 80 cm H2O) was greater (P = .0023) than that measured in 37 horses with nonstrangulating obstruction (NSO) of the large colon (NSO; < or = 180 degrees volvulus or a nonstrangulating displacement; 18 cm H2O; 6 to 46 cm H2O). Sixty-five percent (45 of 69) of horses with SO and all horses with NSO survived. Survival analysis was restricted to 59 horses with large-colon SO that survived to hospital discharge or met the criteria specified for classification as nonsurvivors. Colonic luminal pressure in nonsurvivors (48.5 cm H2O; 34 to 80 cm H2O) was higher (P =.0001) than that measured in survivors (18 cm H2O; 2 to 50 cm H2O) of SO. From response operating characteristic curves, a luminal pressure of 38 cm H2O optimized the distribution of horses with SO into survivor and nonsurvivor groups. Sensitivity, specificity, and positive and negative predictive values for a colonic luminal pressure greater than 38 cm H2O in predicting nonsurvival were 0.89, 0.91, 0.72 and 0.97, respectively. Measurement of colonic luminal pressure may be useful for predicting survival in horses with colonic volvulus.

Animals↗
PubMedDate not supplied

Prenatal rubella.

Explore the source record for details and available documents.

Adult↗
PubMedDate not supplied

Vestibular syndrome and vascular anomaly in the cerebello-pontine angle.

During the investigation of patients presenting symptoms related to the Vth and VIIth nerves, frequently associated symptoms relevant to the VIIth nerve were found, such as tinnitus, disequilibrium or vertigo. On the other hand, there also came to our attention patients whose major complaints were of VIIIth origin, especially of the vestibular component, and who occasionally presented associated symptoms of Vth or VIIth nerve involvement. Following the successful treatment of trigeminal neuralgia and hemi-facial spasm by liberation of the Vth and the VIIth nerve from the mechanical irritative lesion, frequently a vascular loop anomaly, it was postulated that the same cause could be responsible of tinnitus and vertigo, secondary to irritation of the VIIIth nerve, in some cases. The clinical picture of VIIIth nerve involvement in the posterior fossa, either isolated or associated with facial pain or hemi-facial spasm, is presented together with the results of surgical treatment in 5 cases.

Adult↗
PubMedDate not supplied

Diagnostic accuracy of preoperative CT scanning of pituitary prolactinomas.

Between 1980 and 1985, 102 patients (84 women and 18 men) who had coronal CT scans of the sella turcica for suspected prolactin adenoma underwent transsphenoidal exploration. The CT examinations were performed with a fourth-generation EMI scanner (CT 7070), and reports of the preoperative CT examinations were compared with the findings at transsphenoidal exploration. The same neurosurgeon performed all the operations. In 97 patients distinct adenomas were found at surgery, among which were 36 macroadenomas (diameter larger than 10 mm) and 62 microadenomas (one patient had two coexisting microadenomas). All macroadenomas were identified correctly on the preoperative CT scans. Preoperative CT scans correctly localized 58 microadenomas in 57 of 62 patients, for a sensitivity rate of 91.9%; this included correct localization in four patients with recurrent microprolactinomas and in the one patient with two coexisting adenomas. Three patients in whom the adenomas were found in a location other than that reported on the preoperative CT scan were considered to have false-negative scans for the purpose of statistical calculations; two other false negatives occurred in patients whose scans had been interpreted as entirely normal and who were subsequently found to have adenomas at operation. Four patients had negative surgical explorations and the preoperative CT scan was correct in one, for a specificity of 25%. The overall accuracy rate was 92.1% for the entire group of patients and 87.7% for the subgroup of microadenomas. In our experience, coronal CT scanning has high diagnostic accuracy in patients with pituitary prolactinomas.

Adenoma↗
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Diagnostic accuracy of preoperative CT scanning of pituitary somatotroph adenomas.

Between 1980 and 1986, 58 patients (23 women and 35 men) had coronal CT scans of the sella turcica for suspected growth hormone-secreting adenoma and underwent transsphenoidal exploration. The CT examinations were performed with a fourth-generation EMI scanner (CT 7070), and reports of the preoperative CT were compared with the findings at transsphenoidal exploration. The same neurosurgeon performed all the operations. In three patients arthritic changes in the neck caused difficulties in positioning, which made it impossible to obtain adequate coronal CT scans. These nondiagnostic examinations are excluded from the statistical calculations. In all 55 patients with scans that were able to be evaluated, distinct adenomas were found at surgery. Among these were 39 macroadenomas (diameter larger than 10 mm) and 16 microadenomas. Three macroadenomas and two microadenomas caused combined hypersecretion of growth hormone and prolactin. All macroadenomas were localized correctly on the preoperative CT scans (sensitivity 100%), but in two cases there was a discrepancy in size of more than 5 mm compared with the operative findings. Preoperative CT scans correctly localized 13 of 16 microadenomas, for a sensitivity rate of 81.2%. Two patients with negative scans and one patient in whom the adenoma was found in a location other than that reported on the preoperative CT scan were considered to have negative scans for the purpose of statistical calculations. If both correct localization and size estimation within 2 mm of that found at surgery are considered, the accuracy rate was 90.9% for the entire group of patients, 94.9% for those with macroadenomas, and 81.2% for microadenomas.

Adenoma↗
PubMedDate not supplied

[Treatment of the non-functioning hypophyseal adenoma].

Non-functioning pituitary adenoma is a lesion usually large enough to produce loss of vision and often loss of libido. Transsphenoidal microsurgery is the treatment of choice of these patients. Postoperative radiation therapy should be performed in patients with significant residual pituitary adenoma. Some studies have recently reported that somatostatin analogue may be useful as adjuvant medical therapy, at least in order to improve visual field defects.

Adenoma↗
PubMedDate not supplied

[The treatment of prolactinoma].

Prolactinoma is the most common type of secretory pituitary tumor. The clinical presentation varies with age and sex, and the size of the adenoma. The differential diagnosis with nonfunctioning adenoma and hyperprolactinemia is particularly important in selecting an appropriate therapy. The choice of therapy depends on a number of factors including the patient's preference. In cases of radiologically undetectable microprolactinomas, we prefer observation only. However, hypogonadic patients are treated with bromocriptine. Generally, it is our recommendation that almost all of the patients with micro--and macroprolactinomas undergo a primary medical therapy, provided they are willing to continue such therapy on a long term basis. We recommend transsphenoidal surgery for patients who refuse long term medical therapy and in rare cases of prolactinomas which are unresponsive to medical therapy. We also consider surgery as a valuable alternative to medical therapy in patients with microprolactinomas and prolactin below 200 micrograms/L.

Adolescent↗