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K J Taylor

Publications and source records attributed to K J Taylor.

At least 55 records · Page 3Linked to original sources
PubMed1995

Is early detection of ovarian cancer possible?

Advances in medical technology have led to potentially useful techniques for the early detection of epithelial ovarian cancer. Early detection of ovarian cancer is crucial for survival as women found to have Stage I or II disease have a 5-year survival of 90% and 70%, respectively, whereas those with advanced disease (Stage III and IV) have a survival of approximately 20%. The circulating tumour marker CA-125 has been extremely useful in following women known to have epithelial ovarian cancers. It has been employed in differentiating benign tumours from malignancies, and is now being tested in a variety of programmes for its role in the early detection of ovarian cancer. The application of endovaginal ultrasound and colour Doppler flow techniques to early detection of ovarian cancer have resulted in several large series identifying ovarian cancer in 1:1000 to 1:2000 postmenopausal women screened. However, a high false positivity rate persists using CA-125 and ultrasound techniques alone or in sequence. Developments in molecular genetics may be extremely useful in evaluating women with inherited susceptibilities for this disease, but this probably represents only about 3% of the population of the women who develop epithelial ovarian cancer. The cost-benefit analysis of isolated screening for epithelial ovarian cancer using CA-125 and ultrasound techniques, even in women at high risk for the disease, would suggest that such screening is not cost-effective at this time.

Biomarkers, Tumor↗
PubMed1995

Octreotide blunts postprandial splanchnic hyperemia in cirrhotic patients: a double-blind randomized echo-Doppler study.

The effect of octreotide, a long-acting synthetic analog of somatostatin, on fasting and postprandial splanchnic hemodynamics was investigated in cirrhotic patients. Splanchnic hemodynamics were assessed using an echo-Doppler duplex system in a prospective, double-blind, placebo-controlled, crossover study performed on 2 separate days, 1 week apart, in 30 cirrhotic patients. Measurements of portal vein (PV) cross-sectional area (PV-A) and mean velocity (PV-V), and of superior mesenteric artery (SMA) mean velocity (SMA-V) and pulsatility index (SMA-PI) (an index of vascular resistance) were performed at baseline, 30 minutes after octreotide (200 micrograms subcutaneously) or placebo administration, and 30 and 60 minutes after the ingestion of a liquid meal. In the fasted state, octreotide induced a significant decrease in PV-V (-7%) and in SMA-V (-10%) and an increase in PI (+16%). On the day of placebo administration, meal ingestion induced a significant increase in PV-V (+21%) and in SMA-V (+43%) and a decrease in PI (-21%). In contrast, meal ingestion on octreotide day induced significantly smaller increases in PV-V (+10%) and in SMA-V (+18%) and a significantly smaller decrease in PI (-10%). Octreotide, although producing a mild reduction in PV-V and SMA-V in the fasted state, markedly blunts postprandial splanchnic hyperemia in cirrhotic patients.

Aged↗
PubMed1994

Low-dose indomethacin therapy and extension of intraventricular hemorrhage: a multicenter randomized trial.

We enrolled 61 neonates of 600 to 1250 gm birth weight with evidence of low-grade intraventricular hemorrhage at 6 to 11 hours of age in a prospective, randomized, placebo-controlled trial to test the hypothesis that indomethacin (0.1 mg/kg given intravenously at 6 to 12 postnatal hours and every 24 hours for two more doses) would prevent extension of intraventricular hemorrhage. Twenty-seven infants were assigned to receive indomethacin; 34 infants received saline placebo. There were no significant differences between the two groups in birth weight, gestational age, sex, Apgar scores, percentage of infants treated with surfactant, or distribution of hemorrhages at the time of the first cranial sonogram (echo-encephalogram). Within the first 5 days, 9 of 27 indomethacin-treated and 12 of 34 saline solution-treated infants had extension of their initial intraventricular hemorrhage (p = 1.00). Four indomethacin-treated and three saline solution-treated infants had parenchymal extension of the hemorrhage. Indomethacin was associated with closure of a patent ductus arteriosus by the fifth day of life (p = 0.003). There were no differences in adverse events attributed to indomethacin. We conclude that in very low birth weight infants with low grade intraventricular hemorrhage within the first 6 postnatal hours, prophylactic indomethacin therapy promotes closure of the patent ductus arteriosus and is not associated with adverse events, but does not affect the cascade of events leading to parenchymal involvement of intracranial hemorrhage.

Cerebral Hemorrhage↗
PubMed1994

Screening for early ovarian cancer.

There are 20,000 new cases of ovarian cancer per year and over 12,000 deaths in the United States. Seventy percent of women with ovarian cancer have advanced disease at diagnosis, and 5-year survival is less than 30%. Earlier diagnosis is essential to improve prognosis. Risk factors include age, race, ovulation, and family history. New techniques for possible earlier diagnosis include endovaginal color flow ultrasound (US) and measurement of a serum tumor marker, CA 125. CA 125 is only 25% sensitive for early disease and is nonspecific: In premenopausal women, more than 90% of findings are false-positive. Endovaginal color flow US provides superb morphologic detail of malignancy such as mural nodules and solid vascularized components. Low impedance flow has been reported in many cancers but may also be seen in benign masses and in luteal flow. There are technical and economic impediments to earlier diagnosis of ovarian cancer, and more sensitive and specific tumor markers may be required. Current techniques may show only acceptable cost-effectiveness in women at elevated risk by virtue of a family history of the disease.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1994

Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial.

OBJECTIVES: Parenchymal involvement of intraventricular hemorrhage (IVH) is a major risk factor for neurodevelopmental handicap in very low birth weight neonates. Previous trials have suggested that indomethacin would lower the incidence and severity of IVH in very low birth weight neonates. METHODS: We enrolled 431 neonates of 600- to 1250-g birth weight with no evidence for IVH at 6 to 11 hours of age in a prospective, randomized, placebo-controlled trial to test the hypothesis that low-dose indomethacin (0.1 mg/kg intravenously at 6 to 12 postnatal hours and every 24 hours for two more doses) would lower the incidence and severity of IVH. Serial cranial ultrasound examinations and echocardiographs were performed. RESULTS: There were no differences in the birth weight, gestational age, sex, Apgar scores, and percent of neonates treated with surfactant between the indomethacin and placebo groups. Within the first 5 days, 25 (12%) indomethacin-treated and 40 (18%) placebo-treated neonates developed IVH (P = .03, trend test). Only one indomethacin-treated patient experienced grade 4 IVH compared with 10 placebo-treated neonates (P = .01). Sixteen indomethacin-treated neonates and 29 control neonates died (P = .08); there was a difference favoring indomethacin with respect to survival time (P = .06). Eighty-six percent of all neonates had a patent ductus arteriosus on the first postnatal day; indomethacin was associated with significant ductal closure by the fifth day of life (P < .001). There were no differences in adverse events attributed to indomethacin between the two treatment groups. CONCLUSIONS: Low-dose prophylactic indomethacin significantly lowers the incidence and severity of IVH, particularly the severe form (grade 4 IVH). In addition, indomethacin closes the patent ductus arteriosus and is not associated with significant adverse drug events in very low birth weight neonates.

Cerebral Hemorrhage↗
PubMed1993

Endovaginal pulsed and color Doppler in first-trimester pregnancy.

Endovaginal pulsed and color Doppler techniques were used to evaluate 23 unselected first-trimester pregnancies prior to elective abortion. Mean estimated gestational age was 8.9 +/- 1.6 weeks (range = 6.6-13.0). Low impedance, high velocity peritrophoblastic flow was seen in all cases. Mean peak systolic and end-diastolic velocities were 41.0 +/- 19.7 and 22.9 +/- 6.5 cm/s; mean resistance index (RI) was 0.41 +/- 0.10. Forty-five uterine arteries were evaluated with mean peak systolic and end-diastolic velocities of 44.1 +/- 14.7 and 7.6 +/- 4.3 cm/s; mean RI was 0.81 +/- 0.10. The peritrophoblastic and uterine artery velocities did not correlate with gestational age. Both ovaries were evaluated in 14 patients. One had no detectable flow in either ovary. For the active ovary in the other 13 patients, mean peak systolic and end-diastolic velocities were 27.4 +/- 9.9 and 15.2 +/- 5.9 cm/s; mean RI was 0.44 +/- 0.09. The corresponding values for the inactive ovary were 8.9 +/- 3.8 cm/s, 2.0 +/- 2.0 cm/s, and 0.76 +/- 0.22. These results can be used as a baseline for future studies of abnormal pregnancies.

Adult↗
PubMed1993

Endovaginal US and Doppler findings after first-trimester abortion.

Endovaginal ultrasound (US) imaging and color Doppler flow imaging techniques were used to evaluate the uterus and its contents and to establish characteristics of a normal post-abortion appearance in 19 women who underwent elective first-trimester abortions. Twenty-two examinations were performed between 2 and 17 days after the procedure. Thirteen of the 22 examinations (59%) showed different amounts of intrauterine material of varying echogenicity. Seven of the 22 examinations (32%) showed a thick endometrial stripe, and only two showed a normal stripe. Color Doppler flow imaging demonstrated typical peritrophoblastic flow in four of eight patients on the second and third days after the abortions were performed. After the third day, flow was observed in only two of 11 patients, and intrauterine material was also seen. These results indicate that intrauterine material and low-impedance flow are frequently observed after an abortion and do not necessarily indicate clinically important retained products of conception.

Abortion, Induced↗
PubMed1992

A randomized study of propranolol on postprandial portal hyperemia in cirrhotic patients.

Propranolol, a nonselective beta-adrenergic blocker, has been shown to reduce portal pressure and the risk fo variceal bleeding. The portal pressure-reducing effect of propranolol is mediated by splanchnic arterial constriction, which decreases portal flow. A double-blind randomized control study (crossover on 2 consecutive days) was designed to compare the effects of propranolol vs. placebo on portal flow in cirrhotic patients during fasting and after a standardized meal. Portal flow was measured with an ATL Ultramark 8 echo-Doppler system (Advanced Technological Laboratories, Bothel, WA) in 23 cirrhotic patients. Fasting portal flow and heart rate were obtained at baseline and 2 hours after the administration of propranolol or placebo. A standard test meal was then given, and measurements were repeated 30 minutes later. Thirteen patients (group 1) received placebo on day 1 and propranolol on day 2, whereas 10 patients (group 2) received propranolol on day 1 and placebo on day 2. In group 1 patients, heart rate declined by 20% (P less than 0.0001) and portal flow decreased by 12% (P less than 0.05) after propranolol administration. Similar reductions were found in heart rate (-21%, P less than 0.0001) and portal flow (-17%, P less than 0.001) for group 2 patients. For all 23 patients, 2 hours after propranolol administration, heart rate declined by 21% (P less than 0.0001) and portal blood flow was reduced by 14% (P less than 0.0001). The 10 patients who received propranolol on day 1 (group 2) showed a carryover effect of propranolol on day 2. On day 2, baseline portal flow and heart rate values were significantly lower than baseline values on day 1. This long-lasting effect of a single dose of propranolol may be caused by the longer half-life of propranolol in cirrhotic patients. The postprandial portal blood flow percentage increase after the meal was similar for both placebo and propranolol. Propranolol did not blunt postprandial hyperemia. However, whereas the absolute value of blood flow after the meal increased significantly in comparison with baseline in placebo-treated patients (P less than 0.001), this did not occur with propranolol. Furthermore, in propranolol-treated patients the absolute value of blood flow after the meal was lower than in placebo-treated patients. This may constitute a protective effect of propranolol in portal hypertension.

Female↗
PubMed1992

Echo-Doppler evaluation of acute flow changes in portal hypertensive patients: flow velocity as a reliable parameter.

In order to evaluate the behavior of the portal vein cross-sectional area during changes in portal flow, two groups of subjects were analyzed in two blinded cross-over studies using echo-Doppler flowmetry. The first group (I) consisted of 21 patients with cirrhosis and 16 controls. They received a standardized meal which is known to increase portal flow. The second group (II) consisted of 31 patients with cirrhosis who received a dose of propranolol which is known to decrease portal flow. In Group I, 30 min after the meal, the portal vein blood velocity increased by 35 +/- 6% (p less than 0.01) in cirrhotic patients and by 55 +/- 5% (p less than 0.01), in normal subjects. The portal vein cross-sectional area increased significantly in normal subjects (22 +/- 2%, p less than 0.01) but not in cirrhotic patients (4 +/- 2%, n.s.). In Group II, 2 h after propranolol, there was a significant decrease in portal blood velocity (-14 +/- 2%), whereas the portal vein cross-sectional area did not show any significant changes. These data demonstrate that, in portal hypersensitive patients, the portal area measured by echo-Doppler flowmetry can be assumed to be constant and hence its calculation to estimate changes in portal blood flow can be omitted. Therefore, the use of blood velocity alone is suggested to monitor acute changes in flow in portal hypertension using Doppler flowmetry. The elimination of the portal vein cross-sectional area measurement simplifies the quantitative calculation of portal hemodynamics and increases the reliability of the technique by avoiding a source of error.

Aged↗
PubMed1992

Risk factors for early intraventricular hemorrhage in low birth weight infants.

Because earlier studies suggested that preterm infants with germinal matrix hemorrhage or intraventricular hemorrhage or both (GMH/IVH) present within the first 12 postnatal hours are at greatest risk for the development of high-grade hemorrhage and neurodevelopmental disability, we examined the risk factors for this insult among 229 neonates of 600 to 1250 gm birth weight in a multicenter study. All had echoencephalography (ECHO) within the first 11 hours and serially for the next 20 days; risk factor data were collected prospectively. Forty-three infants had GMH/IVH within the first 5 to 11 hours (mean age at ECHO 7.7 hours): 18 GMH and 21 grade II, 1 grade III, and 3 grade IV IVH. One hundred eighty-six infants did not have GMH/IVH at a mean age of 7.9 hours. Both groups of infants were similar in birth weight, gestational age, maternal risk factors, cord pH values, and surfactant therapy before ECHO. The group with early IVH had more vertex presentations than the group without early IVH (79% vs 55%, p = 0.043), less maternal tocolytic use (42% vs 60%, p = 0.029), and more vaginal deliveries (67% vs 44%, p = 0.005). In the first 21 days, severe IVH developed in 12 infants with early IVH and in 6 infants without early IVH (p < 0.001). There were more neonatal deaths (16% vs 6%, p = 0.035) and more deaths at any time during the primary hospitalization (23% vs 9%, p = 0.010) among the early IVH group than among the group without early IVH. Multivariate analysis indicated that the mode of delivery, fetal presentation, and birth weight were important and independent prognostic indicators of IVH.

Birth Weight↗
PubMed1992

Ectopic pregnancy: evaluation with endovaginal color flow imaging.

Endovaginal sonography and endovaginal color flow imaging were compared in 155 patients with clinical suspicion of ectopic pregnancy. Sixty-five patients (42%) had surgically confirmed ectopic pregnancies. Thirty-six of the pregnancies were diagnosed with endovaginal sonography alone, the criteria being an extrauterine sac or ectopic fetus (sensitivity, 54%). Sixty-two ectopic pregnancies were diagnosed with endovaginal color flow imaging (sensitivity, 95%) when an ectopic fetus or sac was seen or placental flow was identified in an adnexal mass separate from the ovary and uterus. The diagnosis of ectopic pregnancy was excluded with endovaginal sonography (specificity, 98%) and endovaginal color flow imaging (specificity, 98%) by finding an intrauterine gestation, nonvisualization of an adnexal mass, and absence of placental flow. Three false-positive and three false-negative diagnoses were made with endovaginal color flow imaging (positive predictive value, 97%). The addition of color Doppler flow imaging to endovaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.

Adult↗
PubMed1992

Doppler color imaging. Peripheral arteries.

The impact of DCI on the evaluation of peripheral vascular disease is considerable. In essence, it is noninvasive angiography without the limitations of that modality. However, the pressure gradient can only be inferred, and pull-through pressure gradients are still the most accurate estimation of adequacy of flow. Nonetheless, segmental blood pressures and the peak velocities measured by duplex Doppler provide a noninvasive alternative for estimating pressure gradients. DCI imaging has greatly improved the perception of focal abnormalities and allows rapid appreciation of global hemodynamics. As further technical refinements improve resolution and sensitivity, color Doppler may eventually supplant angiography as the primary imaging modality in peripheral arterial diagnosis, reserving arteriography for interventional procedures.

Aneurysm↗
PubMed1992

Doppler color imaging. Obstetric and gynecologic applications.

The addition of pulsed and color Doppler has greatly added to the diagnostic potential for obstetric and gynecologic ultrasound. In addition to improved morphologic detail inherent in the use of EVUS, new information is available on perfusion and the physiologic changes associated with the menstrual cycle and early pregnancy. The absence of luteal flow strongly predicts unsuccessful pregnancy outcome in patients undergoing therapy for infertility. This introduces the possibility of more economic use of expensive treatments. Later in pregnancy, DCI aids in the efficient and accurate performance of Doppler spectral sampling and contributes to the evaluation of structural and functional abnormalities of the fetus, umbilical cord, and placenta. Applications in the evaluation of patients with suspected ectopic pregnancy, incomplete abortion, and pseudosac are welcome additions for clinical problems that currently result in many malpractice suits. Finally, the recognition of neovascular flow, especially in the ovary, raises hope for improved and earlier diagnosis of ovarian cancer.

Color↗
PubMed1992

Arterial vascular ultrasonography.

A new generation of high frequency, high resolution ultrasound scanners has provided unprecedented information about the state of the arterial wall in a variety of superficial vessels and can document the disturbed flow within them. The information now available is of great clinical value to many clinicians, including vascular surgeons and subspecialty internists who care for individuals at risk for accelerated atherosclerosis and other vascular diseases.

Arterial Occlusive Diseases↗
PubMed1991

A prognostic system for transient ischemia or minor stroke.

OBJECTIVE: To build a prognostic system for patients with carotid transient ischemic attack or minor stroke. DESIGN: Inception cohort study with 2-year follow-up. SETTING: Urban community teaching hospital. PATIENTS: Eligible patients (n = 142), identified on a carotid ultrasound roster, had been hospitalized between 1984 and 1987 within 30 days of a first carotid transient ischemic attack or minor stroke. MEASUREMENTS: Stroke or death within 2 years. MAIN RESULTS: Three factors were associated with stroke or death: age of more than 65 years, diabetes, and hypertension. Based on regression coefficients, age of more than 65 years was assigned 3 points; diabetes, 3 points; and hypertension, 2 points. An initial prognostic system comprised risk groups 1 (0 points), 2 (1 to 5 points), and 3 (6 to 8 points). Outcome rates in the three groups were 2%, 31%, and 54% (P less than 0.0001), respectively. In an independent test sample, the corresponding outcome rates for the initial system were 12%, 21%, and 31% (P = 0.04). A final prognostic system, including two additional predictors (coronary heart disease [1 point] and the distinction between stroke and transient ischemic attack for the baseline event [2 points]), comprised risk groups 1 (0 to 2 points), 2 (3 to 6 points), and 3 (7 to 11 points). Corresponding outcome rates were 3%, 27%, and 48% (P less than 0.001) in the original cohort and 10%, 21%, and 59% (P less than 0.001) in the test cohort. CONCLUSION: For selected patients with carotid transient ischemia or minor stroke, five clinical features can be combined to stratify effectively the risk for a subsequent stroke or death.

Aged↗