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Biomedical subjects

J W Fletcher

Publications and source records attributed to J W Fletcher.

At least 19 recordsLinked to original sources

Dietary P regulates phosphate transporter expression, phosphatase activity, and effluent P partitioning in trout culture.

Phosphate utilization by fish is an important issue because of its critical roles in fish growth and aquatic environmental pollution. High dietary phosphorus (P) levels typically decrease the efficiency of P utilization, thereby increasing the amount of P excreted as metabolic waste in effluents emanating from rainbow trout aquaculture. In mammals, vitamin D3 is a known regulator of P utilization but in fish, its regulatory role is unclear. Moreover, the effects of dietary P and vitamin D3 on expression of enzymatic and transport systems potentially involved in phosphate utilization are little known. We therefore monitored production of effluent P, levels of plasma vitamin D3 metabolites, as well as expression of phosphatases and the sodium phosphate cotransporter (NaPi2) in trout fed semipu diets that varied in dietary P and vitamin D3 levels. Mean soluble P concentrations varied markedly with dietary P but not with vitamin D3, and constituted 40-70% of total effluent P production by trout. Particulate P concentrations accounted for 25-50% of effluent P production, but did not vary with dietary P or vitamin D3. P in settleable wastes accounted for <10% of effluent P. The stronger effect of dietary P on effluent P levels is paralleled by its striking effects on phosphatases and NaPi2. The mRNA abundance of the intestinal and renal sodium phosphate transporters increased in fish fed low dietary P; vitamin D3 had no effect. Low-P diets reduced plasma phosphate concentrations. Intracellular phytase activity increased but brushborder alkaline phosphatase activity decreased in the intestine, pyloric caeca, and gills of trout fed diets containing low dietary P. Vitamin D3 had no effect on enzyme activities. Moreover, plasma concentrations of 25-hydroxyvitamin D3 and of 1,25-dihydroxyvitamin D3 were unaffected by dietary P and vitamin D3 levels. The major regulator of P metabolism, and ultimately of levels of P in the effluent from trout culture, is dietary P.

6-Phytase↗

Recurrent myxoma of the hand.

Myxoma is a rare benign tumor composed of stellate or spindle-shaped cells in a loose myxoid stroma. Few cases involving the hand have previously been described. We present a rare case of recurrent myxoma in the intermetacarpal space and detail the clinical behavior of this indolent tumor.

Aged↗

Surveillance for recurrent head and neck cancer using positron emission tomography.

PURPOSE: Earlier detection of head and neck cancer recurrence may improve survival. We evaluated the ability of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) to detect recurrence in a prospective trial using sequential PET scans. PATIENTS AND METHODS: Serial posttherapy FDG-PET was prospectively performed in 44 patients with stage III or IV head and neck cancer. PET was performed twice during the first posttreatment year (at 2 and 10 months after therapy) and thereafter as needed. After therapy, patients were grouped, based on tissue biopsies, into those who achieved a complete response (CR) and those who had residual disease (RD). Patients who achieved a CR were further grouped into those without evidence of disease and those who had recurrence by 1 year after completion of therapy. Disease status as determined by physical examination (PE), PET, and correlative imaging was compared. RESULTS: Eight patients were lost to follow-up and six had RD after therapy. Of the remaining 30 patients with a CR, 16 had recurrence in the first year after therapy. Five of these 16 patients had recurrence detected by PET only, four by PET and correlative imaging only, five by PE and PET only, and two by PE, correlative imaging, and PET. Only PET detected all recurrences in the first year. PET performed better than correlative imaging (P =.013) or PE (P =.002) in the detection of recurrence. CONCLUSION: PET can detect head and neck tumor recurrence when it may be undetectable by other clinical methods. FDG-PET permits highly accurate detection of head and neck cancer recurrence in the posttherapy period.

Antineoplastic Combined Chemotherapy Protocols↗

Primary and recurrent early stage laryngeal cancer: preliminary results of 2-[fluorine 18]fluoro-2-deoxy-D-glucose PET imaging.

PURPOSE: To evaluate the effectiveness of 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in the identification of early stage (T1-T2) primary and recurrent laryngeal cancer. MATERIALS AND METHODS: Twelve patients with T1 or T2 laryngeal cancer underwent imaging prospectively with PET. Seven patients had new disease, and five had recurrent disease. All patients underwent imaging prior to planned therapy and tissue biopsy. PET images were evaluated by using standardized uptake ratios and visual analysis. RESULTS: Histopathologic evidence of early stage cancer was documented in the 12 patients. One had a carcinoma in situ, nine had T1 tumors, and two had T2 tumors. Of the 12 patients, 10 had vocal cord tumors, one had a hypopharyngeal tumor, and one had a preepiglottic tumor. Eleven (92%) patients with early stage cancer had standardized uptake ratios indicative of malignancy (mean, 4.6; SD, 1.8; 95% CI, 1.2; range, 2.8-7.6). One had false-negative results (standardized uptake ratio = 2.3). Nine underwent CT, and results in the larynx were normal in seven and abnormal in two. CONCLUSION: FDG PET can be used to identify primary and recurrent early stage laryngeal cancer. It may be useful for follow-up after therapy.

Carcinoma in Situ↗

Prospective investigation of positron emission tomography in lung nodules.

PURPOSE: Solitary pulmonary nodules (SPNs) are commonly identified by chest radiographs and computed tomography (CT). Biopsies are often performed to evaluate the nodules further. An accurate, noninvasive diagnostic test could avoid the morbidity and costs of invasive tissue sampling. We evaluated the ability of fluorine-18 deoxyglucose positron emission tomography (FDG-PET) to discriminate between benign and malignant pulmonary nodules in a prospective, multicenter trial. METHODS: Eighty-nine patients who had newly identified indeterminate SPNs on chest radiographs and CT were evaluated with FDG-PET. PET data were analyzed semiquantitatively by calculating standardized uptake values (SUVs) as an index of FDG accumulation and also by a visual scoring method. PET results were compared with pathology results. RESULTS: Sixty SPNs were malignant and 29 were benign. Using SUV data, PET had an overall sensitivity and specificity for detection of malignant nodules of 92% and 90%. Visual analysis provided a slightly higher, but not statistically significant, sensitivity of 98% and lower specificity of 69%. For SPNs < or = 1.5 cm (34 of 89), the sensitivity and specificity of SUV and visual analysis were 80% and 95% and 100% and 74%, respectively. CONCLUSION: FDG-PET can accurately characterize indeterminate SPNs. PET imaging provides a noninvasive method to evaluate indeterminate SPNs, which can reduce the need for invasive tissue biopsy.

Aged↗

Evaluation of chemotherapy response in patients with advanced head and neck cancer using [F-18]fluorodeoxyglucose positron emission tomography.

BACKGROUND: [F-18]Fluorodeoxyglucose (FDG)-positron emission tomography (PET) can measure the metabolic activity of tissues; FDG-PET may be able to predict response to chemotherapy by identifying changes in tumor metabolism. Measurement of response to treatment may help improve survival in the management of advanced head and neck cancer. We evaluated this particular use of FDG-PET in patients participating in a neoadjuvant organ-preservation protocol using taxol and carboplatin and compared pathologic response after chemotherapy with changes in tumor metabolism measured by FDG-PET. METHODS: Serial FDG-PET studies (n = 56) were performed in patients (n = 28) with stage III/IV head and neck cancer participating in a neoadjuvant organ-preservation protocol. The FDG-PET studies were performed before and after chemotherapy. All patients had tissue biopsies before and after chemotherapy. Patients were classified as pathologic complete response (PCR) or residual disease (RD) based on tissue biopsies. Visual analysis of PET scans was performed to identify patients with complete response by PET, and these findings were compared with pathology results. Metabolic changes were also evaluated using standardized uptake ratios (SUR) of FDG. RESULTS: The sensitivity and specificity of PET for residual cancer after therapy was 90% (19/21) and 83% (5/6), respectively. Two patients had initially negative biopsies and positive PET studies for persistent disease. Pathology review and rebiospy led to confirmation of the PET results in these cases, giving a sensitivity of 90% for initial tissue biopsy. CONCLUSIONS: In this preliminary analysis, FDG-PET was accurate in classifying response to chemotherapy in most patients. Fluorodeoxyglucose-PET may identify residual viable tumor when it is otherwise undetectable.

Animals↗

Quantitative technetium-99M dimercaptosuccinic acid renal scanning in children.

OBJECTIVES: To develop a method for assessing absolute renal function (as well as morphology) in children, using gamma camera imaging of intravenously injected technetium-99m (99mTc) dimercaptosuccinic acid (DMSA). METHODS: Forty-five children (ages 1 week to 10 years; mean, 2.0 years) were imaged using a planar technique in which not only the appearance but the absolute amount of intravenously administered 99mTc DMSA taken up by the kidneys was calculated for each child and compared with contemporaneous determinations of creatinine clearance. RESULTS: There was a close correlation between the absolute DMSA uptake and creatinine clearance (r = 0.752). CONCLUSIONS: Renal function in children, expressed as creatinine clearance, can be accurately estimated by measuring absolute DMSA uptake with planar gamma camera imaging using 99mTc DMSA.

Child↗

Coronary arteriographic findings in black patients and risk markers for coronary artery disease.

Coronary arteriographic results are reported in 1535 black patients: 751 men (mean age 57 +/- 11) and 784 women (mean age 59 +/- 11). Among the black men 19%, 15%, 21%, and 4% had single-, double-, and triple-vessel and left main disease, respectively. Among the black women there were 12%, 10%, 15%, and 3% with similar involvement. Logistic regression models showed that most of the recognized risk factors were positively correlated with significant (at least one artery with > or = 50% stenosis) coronary disease, but a history of hypertension was not a significant independent predictor in either sex. ECG evidence of previous infarction increased the odds of detecting significant coronary disease by the greatest amount when controlling for other significant risk markers in women. In men both previous infarction and atypical pain (negative) were equally important. This study confirms but does not explain previous reports that have revealed less than expected angiographic evidence of significant coronary artery disease in black compared with white persons.

Analysis of Variance↗

Consensus development for producing diagnostic procedure guidelines: SPECT brain perfusion imaging with exametazime.

UNLABELLED: A method for developing diagnostic practice guidelines is presented in which a team of experts used a semiquantitative scoring system to reach consensus on a standard procedure for SPECT cerebral perfusion imaging. METHODS: An expert panel generated a list of elements that they thought were important for the optimal performance of cerebral perfusion imaging as the first phase of a modified Delphi panel technique. Panel members then scored each statement to indicate the importance of that statement for the performance of cerebral perfusion imaging. The scores were recorded for each statement and the average score, s.d. and variance for each statement were determined for each successive panel round. A total of three panel rounds were conducted. The change in average s.d. between scoring rounds was analyzed for significance using both parametric and nonparametric tests. RESULTS: The average s.d. decreased by 35% from 2.1 to 1.32 between the first and final panel round. This change in average s.d., which indicated enhanced consensus, was significant at p < 0.0001. Following consensus, all statements were grouped into four categories based on average score: critical elements, important elements, less important elements and elements of uncertain importance. This grouping formed the basis for a guideline summary narrative. Results were generated in 3 mo, at low cost and with clear documentation of rationale. CONCLUSION: Through simple adaptations of this methodology, expert panels that develop practice guidelines can replace informal discussion with systematic scoring methods to rate the quality of evidence, generalizability to practice conditions, appropriate indications and strength of recommendations.

Brain↗

Testicular circulatory isolation in man: comparison of radionuclide angiography with Doppler evaluation.

Testicular circulatory isolation (TCI) holds promise as a method to avoid drug-induced infertility in male patients about to receive cancer chemotherapy. Complete exclusion of blood flow to the testicle is essential to the success of this technique. We have compared the hand-held Doppler probe and radionuclide angiography (technetium-99m pertechnetate) as monitors of testicular blood flow in 10 patients subjected to unilateral TCI. When Doppler evaluation indicated that testicular circulation had been interrupted, the radionuclide angiogram uniformly confirmed and quantified this conclusion. These results validate the hand-held Doppler as an appropriate tool for assessing testicular blood flow in patients undergoing TCI.

Aged↗

Observer reliability in CT and MRI of the abdomen/pelvis.

The purpose of this research was to evaluate two sources of error in the performance of computerized tomography (CT) and magnetic resonance imaging (MRI) of the abdomen/pelvis. The sources of error assessed were inter- and intra-observer reliability. Thirty abdomen/pelvis CT scans were randomly selected from each of three hospitals (university, VA, military) with different CT scanners. Two radiologists were recruited from each site to be CT observers. Forty-five abdomen/pelvis MRI scans were randomly selected from two institutions with different MRI scanners. Four observers were recruited to read the MRI scans. All scans were read blind without clinical information or patient identification. Overall inter-observer and intra-observer diagnostic agreement was significantly higher for MRI compared to CT. Inter-observer diagnostic agreement rates were also significantly higher for MRI when the etiologies of neoplastic vascular and metabolic/toxic were assigned. Observer experience in CT (range: 5-9 yr) or MRI (range: 2-4 yr) was not statistically associated with improved diagnostic agreement. This research addresses many of the criticisms of the MRI literature and compares MRI favorably to CT.

Abdomen↗

Practice pattern variation between two medical schools.

This study examined physician test-ordering behavior at a large urban Veterans Administration Medical Center staffed by two medical schools. Patients are assigned randomly to the two schools' wards, which operate independently of each other. The medical records of 119 patients, admitted during a 5-month period, were abstracted for data on the process and outcomes of medical care. Only one statistically significant difference in diagnostic testing practices was revealed by the observation that 12% of patients on one service received another abdominal film, while no patients on the other service did. The implications of studies such as this for small-area analysis are discussed. If variation in the utilization of health services is observed in a geographic region, then a study of physician behavior at a single facility may help to identify the reason for the variation.

Diagnosis-Related Groups↗

High signal intensity soft tissue masses on T1 weighted pulsing sequences.

On T1 weighted pulsing sequences, the majority of soft tissue masses are of low signal intensity and show high intensity signals on T2 weighting. There however is a subset of soft tissue masses of varied histology that shows high signal intensity on T1 weighted pulsing sequences. These masses have either fat or blood in their substance. Lipomatous and hemangiomatous lesions that did not show high-signal intensity on T1 weighting were also encountered and are discussed. Present experience with MRI of soft tissue masses suggests that there is a limited spectrum of entities that produce high-signal intensity T1 weighted soft tissue masses.

Cysts↗