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Biomedical subjects

K Ward

Publications and source records attributed to K Ward.

At least 109 records · Page 6Linked to original sources
PubMed1994

Successful treatment of multisystem Langerhans cell histiocytosis (histiocytosis X) with etoposide.

PURPOSE: Langerhans cell histiocytosis (LCH) in its disseminated form usually occurs in the very young, and has a fulminant, rapidly progressive, and fatal course despite different forms of therapy. PATIENTS AND METHODS: We treated two patients, who had failed on vinblastine treatment, with i.v. etoposide (VP-16) at a dose of 150 mg/kg/day for 3 days. Patient I, 8 months of age, presented with failure to thrive and huge bilateral granulomatous lesions of the external auditory canal with erosion and extensive destruction of the petrous pyramids and mastoid area. Patient II, 20 months of age, presented with widespread purpuric skin rash, hepatosplenomegaly, and bone marrow involvement. RESULTS: Both patients sustained complete remission (CR) following three to six courses of VP-16 and continued to be in unmaintained CR for > 48 months from diagnosis. No major toxicity was noted. CONCLUSIONS: Etoposide (VP-16), an epipodophyllotoxin known for its usefulness in the treatment of malignancies of the monocyte/macrophage lineage, appears to be an effective treatment for the severe multisystem (disseminated) LCH of childhood and should be strongly considered as front-line therapy for this subgroup of patients with poor prognostic factors.

Etoposide↗
PubMed1994

Do patients read health promotion posters in the waiting room? A study in one general practice.

BACKGROUND: General practitioners are aware of the need to provide easily accessible health promotion information for their patients. Although many practices use health promotion posters in their surgeries, there appears to have been no formal evaluation of their effectiveness. AIM: A study was undertaken to investigate whether patients read and remembered waiting room posters, and if so, what factors influenced this. METHOD: A short questionnaire was distributed to patients in one practice following their consultation. It asked what they remembered of the poster display in the waiting room. RESULTS: Of 319 patients attending a doctor during the study period 82% said they had noticed the posters, 95% of whom reported they had also read them. Patients over 50 years of age were significantly more likely to say they had read the posters than younger patients, but significantly fewer showed interest in further information. The sex of patients did not influence their reading of posters or their interest in further health promotion literature. The longer patients had to wait for the doctor, the more likely they were to remember the subject of the posters correctly. Some subjects appeared to attract more patients' attention than others, in particular the displays about smoking cessation and about the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS). Overall 53% said they would be interested in more information. CONCLUSION: Patients say they read and remember the subject of waiting room posters. Posters in the waiting room can increase awareness of health promotion issues.

Adolescent↗
PubMed1994

Differences in symptoms during and post PTCA versus rotational ablation.

Percutaneous transluminal coronary rotational ablation (PTCRA) has emerged as an effective therapy for the treatment of coronary artery disease. However, nursing management of these patients may differ from standard practices designed to care for coronary balloon angioplasty (PTCA) patients. To examine factors that could impact nursing care we compared 233 patients undergoing PTRCA with 301 patients undergoing PTCA. Overall, clinical success did not differ between the groups. Patients undergoing PTCRA were more likely to experience hypotension and prolonged angina in the cardiac catherization laboratory than patients undergoing PTCA. PTCRA patients were also more likely to require i.v. heparin and i.v. nitroglycerin post procedure than PTCA patients. In addition, PTCRA patients were on i.v. nitroglycerin for longer periods of time post procedure than PTCA patients. There were no differences between the groups in the occurrence of peripheral bleeding, hematoma, or length of hospital stay. In summary, PTRCA patients have more hypotension and angina during rotational ablation procedures, and are more likely to require heparin and nitroglycerin post procedure. These differences require nursing strategies which incorporate closer monitoring of patients and patients' symptoms, along with educating patients about the need for longer i.v. drug therapy.

Aged↗
PubMed1993

Autosomal dominant multiple café-au-lait spots and neurofibromatosis-1: evidence of non-linkage.

Multiple café-au-lait spots have been observed in successive generations of several families without any other manifestations of neurofibromatosis (NF) or any other systemic disorder. The café-au-lait spots in these families segregate as an autosomal dominant trait. The relationship (if any) between the gene for this trait and the NF-1 gene has previously been unknown. We describe a family with five individuals spanning four generations with dominantly inherited café-au-lait spots, without any other stigmata of NF-1. Linkage analysis with probes proximal, distal, and within the NF-1 gene indicate that the trait in this family is not linked to NF-1. We propose that this condition be called Familial Café-Au-Lait Spots (FCAL) to distinguish it from the neurofibromatosis syndromes.

Alleles↗
PubMed1993

Mosaic methylation in clonal tissue.

Current models suggest that de novo methylases add methyl groups to mammalian DNA early in development, establishing cell-specific patterns of methylation, and that these patterns are maintained by maintenance methylases that copy them onto newly replicated DNA strands. To test the prediction that clonal populations of histologically homogeneous cells should, therefore, have homogeneous methylation patterns, we studied methylation in leiomyomas. Despite the clonality and histological homogeneity of these solid tumors, we found that cells were heterogeneously methylated at a number of genomic sites. The heterogeneity was not caused by random methylation events within the leiomyomas because methylation patterns were similar in the core and periphery of a given tumor, and similar also among samples of independent leiomyomas and surrounding myometrial tissues extracted from a single uterus. Our results also showed that methylation of a site in the YNZ22 locus--in leiomyomas and in smooth muscle--was determined independently from the methylation of a neighboring site. Similar results were obtained for the IGH locus in colon and in several tumor tissues. These data indicate that methylation patterns are not identical in progeny cells, as current models suggest. Instead, it seems likely that methylation of a specific site reflects an equilibrium frequency defined by a continual loss and gain of methyl groups. Hence, the specificity found for the methylation of mammalian tissues is not achieved by strictly determining the methylation fate of individual cells, but by determining the overall methylation frequencies for individual sites.

Cell Differentiation↗
PubMed1993

Cardiovascular effects of lightning strikes.

OBJECTIVES: The purpose of this study was to investigate the effects of lightning strikes on the cardiovascular system. BACKGROUND: A lightning strike can attack its victims in one of three ways: direct hit, splash or ground strike. The cardiovascular system can be affected directly by mechanical or electrical trauma during a direct hit or can be indirectly affected through effects on the total body with extensive catecholamine release or autonomic stimulation. Reported effects include hypertension, tachycardia, nonspecific electrocardiographic (ECG) changes including prolongation of the corrected QT (QTc) interval, transient T wave inversion and myocardial necrosis with creatine kinase-MB (CK-MB) fraction release. METHODS: Nineteen victims from five separate lightning strikes were studied over a 2-month period. Each patient was evaluated by serial ECG, CK-MB determinations and echocardiography. RESULTS: The early (0 to 72 h) effects of lightning were demonstrated on the ECG by ST segment elevation consistent with acute current of injury, prolonged QTc interval with direct hits and nonspecific ST and T wave changes. On echocardiography, segmental or global ventricular dysfunction was seen, and pericardial effusion was also detected. During the intermediate (3- to 14-day) period, new and often marked ECG changes consistent with pericarditis or ischemia were seen. No new echocardiographic changes were detected, however, and the early abnormalities including severe left ventricular dysfunction with cardiogenic shock have reversed. The late (1 to 12 months) period revealed only one patient with long-term sequelae (recurrent pericarditis that persisted for 5 months). CONCLUSIONS: Unless both entrance and exit sites are limited to the lower limbs, direct and splash lightning strikes cause myocardial damage as assessed by abnormal serum enzyme determinations or abnormal echocardiographic findings. Only direct hits resulted in echocardiographic abnormalities or a prolonged QTc interval. The degree of myocardial injury can be severe with left and right ventricular ejection fraction < 15% and can be reversible.

Adult↗
PubMed1993

A molecular variant of angiotensinogen associated with preeclampsia.

Pregnancy-induced hypertension (PIH) is a heterogeneous disorder which complicates 5-7% of all pregnancies and remains a leading cause of maternal, fetal and neonatal morbidity and mortality. Severe preeclampsia is the most distinctive and life-threatening form; a multi-system disorder more common in first pregnancies, it is characterized by high blood pressure and proteinuria. In a series of Caucasian women with pregnancy-induced hypertension, we have observed a significant association of preeclampsia with a molecular variant of angiotensinogen, T235, found previously to be associated with essential hypertension. This finding is corroborated in a sample ascertained in Japan. Together, these observations support a new pathophysiological interpretation of preeclampsia and of its relation to some forms of essential hypertension.

Angiotensinogen↗