Search PubMed⌕ Search

Biomedical subjects

L Howard

Publications and source records attributed to L Howard.

156 records · Page 9Linked to original sources
PubMedDate not supplied

Granulomatous inflammation of the breast in a pregnant woman: report of a case with fine needle aspiration diagnosis.

BACKGROUND: Granulomatous inflammation of the breast is an inflammatory process with multiple etiologies. It can accompany breast carcinoma or be idiopathic. It often presents clinically in a fashion mimicking carcinoma. Idiopathic granulomatous mastitis is strongly associated with lactation and is reported to occur in postpartum patients. This is the second fine needle aspiration (FNA) report of idiopathic granulomatous inflammation in the breast of a pregnant woman. CASE: A 27-year-old, 7-month-pregnant woman presented with a hard nodule in her right breast; on ultrasound examination it showed mixed echogenicity, suspicious for carcinoma. FNA showed granulomatous inflammation. The smears were highly cellular, with many clusters of and single epithelioid cells displaying moderate pleomorphism and prominent nucleoli in a background composed of neutrophils, plasma cells, lymphocytes and multinucleated cells. Core needle biopsy revealed a nonnecrotizing, granulomatous lesion. CONCLUSION: The diagnosis of granulomatous inflammation can be challenging, and the cytologic features can be difficult to separate from those of carcinoma. The relatively rare occurrence of this lesion and its cytologic features make it a potentially difficult diagnosis and diagnostic pitfall.

Adult↗
PubMedDate not supplied

Changes in lipoprotein cholesterol distribution in weight-stable postjejuno-ileal bypass patients.

The influence of the jejuno-ileal bypass procedure upon serum lipoproteins was investigated. Lipoprotein cholesterol distribution was measured in 12 jejuno-ileal bypass subjects. The results were compared to 12 obese controls and 12 normal weight controls. In the bypass group, total cholesterol and low density lipoprotein cholesterol concentration was significantly reduced compared to both control groups. The high density lipoprotein cholesterol concentration in the bypass group was not significantly different when compared to the obese control group and in fact both obese groups had high density lipoprotein cholesterol levels significantly less than the normal weight controls. In the bypass group, the high density lipoprotein/low density lipoprotein cholesterol ratio was significantly increased compared to both control groups. These findings suggest a decreased atherogenic potential in jejuno-ileal bypass patients.

Adolescent↗
PubMedDate not supplied

Decreased plasma fibronectin during starvation in man.

This study evaluated the effect of 5 days of starvation followed by 5 days of refeeding on immunoreactive plasma and serum fibronectin and associated opsonic activity as studied by peritoneal macrophage monolayer bioassay in 12 healthy women volunteers. The temporal alteration of fibronectin was compared with the serum albumin, total iron-binding capacity, and retinol-binding protein levels. Fibronectin concentration and opsonic activity were also determined in two cachectic patients who were 61 and 78% of their ideal body weight. Prior to starvation, plasma fibronectin was 292 +/- 20 micrograms/ml and serum fibronectin was 182 +/- 16 in all subjects. After 5 days of starvation, immunoreactive fibronectin decreased (p less than 0.05) by 20-25%. This decrease was not great enough to impair opsonic activity as tested by the in vitro macrophage assay. Starvation caused no decrease in serum albumin or total iron-binding capacity, although retinol-binding protein decreased by 35%. During refeeding, subjects were randomized to a diet with (n = 6) and without (n = 6) carbohydrate. After 5 days of refeeding, fibronectin levels were normalized on the carbohydrate-containing diet, but were still low (82% of normal) on the carbohydrate-free diet. Retinol-binding protein did not fully normalize after 5 days of refeeding. In the two cachectic patients, fibronectin levels prior to total parenteral nutrition were 25 and 75% of normal. Thus, starvation can lower fibronectin levels and this protein is rapidly restored with adequate nutrition.

Adult↗
PubMedDate not supplied

A review of the current national status of home parenteral and enteral nutrition from the provider and consumer perspective.

Home parenteral and enteral nutrition (HPEN) has grown rapidly in the past decade. By examining data from physician reports, patient surveys, and the infusion industry, this review attempts to delineate the diagnostic indications, age range, mortality, medical complications and rehabilitation potential of HPEN patients. A clear trend exists towards greater use of this expensive therapy in bowel obstructed cancer patients and in pediatric and geriatric age groups. Complications in parenterally fed patients appear to result in a readmission to the hospital, on average, once every 2 yr. Life expectancy depends heavily on the underlying diagnosis: whereas 50% of the patients with a malignancy survive only 6 months, 50% without a malignancy survive beyond 3 yr. Fifty to 60% of HPEN patients are able to work full time or part time, 15 to 20% are retired or of preschool age, and 20 to 30% are unable to work. The home care service options considered most important by patients are the pharmacy premixing of intravenous solutions, home delivery of supplies by the home service carrier, reimbursement management by the home care service and the availability of a nurse for an initial home visit and 24-hr emergency backup. In regard to fiscal concerns one of the difficult issues that should be addressed is the separation of medical coverage from disability status; another is that enteral feedings can sometimes be a less expensive alternative to parenteral feedings but little information exists about the complications and outcome with this modality and its fiscal reimbursement is much less assured.

Adolescent↗
PubMedDate not supplied

Five years of experience in patients receiving home nutrition support with the implanted reservoir: a comparison with the external catheter.

This study examines 5 years (1983-1988) of home parenteral nutrition (HPN) experience in 27 patients using the implanted reservoir for venous access. Their catheter-related complications are compared to two control populations using the external catheter. Group I compares the 46 patients who all started HPN in the same 5-year period, group II compares 17 patients with experience of both types of venous access. For the entire 58 patients the average infusion time was 22 months (1 month-8.2 yr) and the average complication rate was about one complication every 2 years. Analyzing the separate groups however, group I implanted reservoir patients did better than those with the external catheter (p less than 0.05) and group II external catheter patients did better than those with the implanted reservoir (p less than 0.05). A possible explanation for this discrepancy is the greater medical competence of group I patients selecting the reservoir. The data show a clear separation of patients into those who have minimal complications with either device and others who have several complications with both. Two-thirds of the complications were infectious, one third mechanical. The infectious complications were similar with both catheters; clotting was more common with the external catheter and skin erosion was seen only with the reservoir. Eighty % of patients with experience with both type of venous access preferred the implanted reservoir.

Adolescent↗
PubMedDate not supplied

Four years of North American registry home parenteral nutrition outcome data and their implications for patient management.

The OASIS Registry started annual collection of longitudinal data on patients on home parenteral nutrition (HPN) in 1984. This report describes outcome profiles on 1594 HPN patients in seven disease categories. Analysis showed clinical outcome was principally a reflection of the underlying diagnosis. Patients with Crohn's disease, ischemic bowel disease, motility disorders, radiation enteritis, and congenital bowel dysfunction all had a fairly long-term clinical outcome, whereas those with active cancer and acquired immunodeficiency syndrome (AIDS) had a short-term outcome. The long-term group had a 3-year survival rate of 65 to 80%, they averaged 2.6 complications requiring hospitalization per year, and 49% experienced complete rehabilitation. The short-term group had a mean survival of 6 months; they averaged 4.6 complications per year and about 15% experienced complete rehabilitation. The registry data also indicated HPN was used for 19,700 patients in 1987 with therapy growth averaging about 8% per year. This growth was chiefly from new cancer patients. The number of new patients with long-term disorders in whom HPN was initiated appeared rather constant. We conclude that these clinical outcome assessments justify HPN for long-term patients, but the utility and appropriateness of HPN for the cancer and AIDS patients remains uncertain and requires further study. Medical, social, and fiscal aspects of HPN management in long-term and short-term patients appear to involve quite separate considerations.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Home parenteral nutrition in patients with a cancer diagnosis.

The clinical outcome for 1362 patients with active cancer managed on home parenteral nutrition (HPN) is compared with that of 122 patients with radiation enteritis ("cured" cancer) and 416 patients with Crohn's disease. This longitudinal clinical information was reported to the North American Home Parenteral and Enteral Nutrition Registry (Oley Foundation/A.S.P.E.N. joint project) between 1985 and 1989. The data shows that the number of active cancer patients on this therapy is increasing 13% per year. The annual survival rate is 25% for patients with active cancer, as compared with 88% for patients with radiation enteritis and 95% for patients with Crohn's disease. Although 50% of all active cancer patients starting HPN are dead within 6 to 9 months, the prognosis is somewhat better in children, and 20% of these active cancer patients appear to do well, returning to full oral nutrition and experiencing complete rehabilitation. These are presumed to be patients with a potentially curable cancer requiring super-aggressive treatment, which causes temporary severe gastrointestinal dysfunction. Adult active cancer patients have the same rehospitalization rate for HPN complications (once per year) as radiation enteritis and Crohn's disease patients. However, their rehospitalization rate for non-HPN complications is four times higher. This article reviews the factors that may explain the growth of HPN in active cancer patients and discusses some of the unanswered clinical questions that urgently need to be addressed to more effectively determine the appropriateness or inappropriateness of HPN management in the active cancer setting.

Adolescent↗