Biomedical subjects
L Martin
Publications and source records attributed to L Martin.
Bilateral conductive deafness related to erosive lichen planus.
A case of bilateral progressive stenosis of both external auditory canals with resultant conductive hearing loss is presented. The stenosis revealed multifocal erosive and synechiant lichen planus. To our knowledge, this is the first reported case of lichen planus involvement of the external ear.
Solitary plasmacytoma of the lung with light chain extracellular deposits: a case report and review of the literature.
AIMS: We present the clinical and histopathological findings of an unusual pulmonary plasmacytoma associated with light chain deposits. METHODS AND RESULTS: The tumour was located in the main left stem bronchus 40 mm from the carina. Histologically, it was composed of sheets of well differentiated plasma cells. Large extracellular deposits of amorphous material were observed in the tumour. These deposits were Congo red negative and contained kappa light chains. They were electron dense granular and non-filamentous. No plasmacytosis was identified by bone marrow biopsy and no monoclonal spike was shown by serum and urine electrophoresis. CONCLUSIONS: Our case is unusual in being endobronchial and showing light chain deposition.
Prognostic comparison of the pathological classifications of gastric cancer: a population-based study.
AIMS: There is controversy over the value of the pathological classifications of gastric carcinomas in the prediction of patient survival. This study was designed to assess the prognostic value of four widely used pathological classifications, in addition to classical prognostic factors. METHODS AND RESULTS: Records from the population-based registry of digestive tract tumours in the department of Côte d'Or (France) have been analysed. All available histopathological slides of gastric cancer resected between 1976 and 1985 were reviewed and classified according to World Health Organization (WHO), Laurén, Ming and Goseki pathological coding systems. A relative survival analysis was performed using a relative survival model with proportional hazard applied to net mortality by interval. WHO, Laurén or Goseki classifications were not found to be independent prognostic factors. In addition to advanced age group, depth of parietal involvement, nodal involvement, presence of metastases, tumour site and gross appearance of the tumour, the Ming's infiltrative type was associated with a lower survival. CONCLUSION: This study suggests an independent prognostic value of the Ming subtypes with respect to survival in patients resected for gastric carcinoma.
The so-called striated muscle hamartoma is a hamartoma of cutaneous adnexa and mesenchyme, but not of striated muscle.
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Evaluation of a rapid homogeneous method for direct measurement of high-density lipoprotein cholesterol.
We evaluated the performance of a direct Liquid N-geneous HDL-C assay (N-HDL; Genzyme Diagnostics, Cambridge, Mass) and compared it with a Centers for Disease Control and Prevention (CDC) modified reference procedure (M-REF) and phosphotungstic acid (PTA) precipitation method in patients with normotriglyceridemia (triglyceride level, <400 mg/dL) and hypertriglyceridemia (triglyceride level, > or =400 mg/dL). Excellent intra-assay and interassay coefficients of variation were obtained (<2.0%) using the N-HDL assay. The N-HDL and PTA assays correlated well with M-REF in normotriglyceridemic samples. In hypertriglyceridemic samples, however, the N-HDL method exhibited better correlation with M-REF than the PTA assay. In addition, compared with M-REF, the mean absolute percentage bias of N-HDL was lower than the PTA assay in normotriglyceridemic (4.9% vs 5.8%) and hypertriglyceridemic (5.4% vs 12.9%) samples. Hemolysis, ascorbic acid, and bilirubin did not interfere with the N-HDL assay. On the basis of these findings, the N-HDL assay compares favorably with the modified CDC reference method and seems superior to the PTA assay. It also has the advantage of being suited for complete automation and, thus, would prove useful in large clinical laboratories.
Mycophenolate mofetil in cyclosporin-associated thrombotic microangiopathy.
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Is atheroembolic disease a new differential diagnosis of pulmonary-renal syndrome?
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Can surgeons evaluate emergency ultrasound scans for blunt abdominal trauma?
OBJECTIVE: To determine whether surgeons and residents with minimal training can evaluate accurately emergency ultrasound (US) examinations compared with radiologists for blunt abdominal trauma. METHODS: Over 7 months, we conducted a prospective study comparing the evaluation of emergency US for blunt abdominal trauma by surgeons and attending radiologists. US readings from the surgical team and the radiologists were correlated with outcome. RESULTS: One hundred-twelve patients were included in the study. Ninety-two patients had an US read as negative by the surgical and radiology services with no subsequent injuries identified. Eighteen patients had an US deemed positive by the surgical service and radiologists. Injuries were confirmed in this group by operation or computed tomography. One patient had an US deemed positive by the surgical team and subsequently negative by the radiologist. A diagnostic peritoneal lavage was performed which was negative. Another patient had an US interpreted as negative by the surgical evaluator and positive by the radiologist. Exploratory laparotomy was negative for intraabdominal hemorrhage or organ injury. Overall results reveal an accuracy on US reading of 99% for the surgical team and 99% for the attending radiologists. CONCLUSION: Surgeons and surgical residents at different levels of training can accurately interpret emergency ultrasound examinations for blunt trauma from the real-time images, at a level comparable to attending radiologists.
Phenotypic and genotypic characterization of virulent yersinia enterocolitica strains unable to ferment sucrose.
Several atypical sucrose-negative Yersinia strains, isolated from clinical samples and sometimes associated with symptoms, proved to have full virulence potential in in vitro and in vivo testings. DNA-relatedness studies revealed that they were authentic Yersinia enterocolitica strains. Therefore, atypical sucrose-negative Yersinia isolates should be analyzed for their virulence potential.
Phase II trial of hyperfractionated accelerated radiation therapy for nonresectable non-small-cell lung cancer: results of Eastern Cooperative Oncology Group 4593.
PURPOSE: To assess the feasibility, toxicity, and efficacy of hyperfractionated accelerated radiation therapy (HART) for non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Thirty patients from six institutions with stage IIIA or IIIB NSCLC were enrolled between November 1993 and August 1995. Radiation therapy (total dose, 57.6 Gy in 36 fractions) was delivered over 15 days with the use of three daily fractions with a 4-hour interval between fractions and an 8-hour interval between on-cord fields. Patients were not treated on weekends. RESULTS: Twenty-eight patients (93%) completed radiation therapy. Treatment-related toxicities of grade 3 or greater included esophagitis in six patients and grade 3 skin reaction in three patients. The overall objective response rate was 54%, and the response rate within the radiation field was 64%. With a minimum follow-up of 19 months in surviving patients, the median survival and 1-year survival rate are 13 months and 57%, respectively. The median relapse-free survival and 1-year relapse-free survival rate are 7 months and 23%, respectively. No transverse myelitis or late toxicities of grade 4 or greater have been observed. CONCLUSION: HART, delivered to a total dose of 57.6 Gy over 15 total days, is practical and well tolerated. Survival appears similar to that seen with modern combined modality regimens. A phase III trial is under way.
Phase II trial of paclitaxel, fluorouracil, and cisplatin in patients with advanced carcinoma of the esophagus.
PURPOSE: We have previously identified paclitaxel as an active single agent in the treatment of esophageal cancer. We performed a phase II trial of paclitaxel in combination with cisplatin and fluorouracil (5-FU), conventionally used chemotherapy for esophageal cancer. The antitumor response, toxicity, and survival of patients treated with the three-drug regimen were evaluated. PATIENTS AND METHODS: Sixty-one patients with advanced, surgically unresectable, or metastatic squamous cell or adenocarcinoma of the esophagus were treated. No prior chemotherapy was allowed. Thirty patients had adenocarcinoma and 31 patients had squamous cell carcinoma. The majority (47 patients; 77%) had metastatic disease and 14 patients (23%) had an unresectable primary or locally recurrent tumor. Patients received paclitaxel 175 mg/m2 by 3-hour infusion day 1; cisplatin 20 mg/m2 daily days 1 through 5, and 5-FU by continuous infusion at a dose of 1,000 mg/m2 daily days 1 through 5. Because of toxicity observed in the first 10 patients treated, the starting dose of 5-FU was subsequently reduced to 750 mg/m2 daily in the remaining patients. A planned attenuation of cisplatin to 15 mg/m2 daily was made after the first three cycles. Granulocyte colony-stimulating factor (G-CSF) was not routinely administered unless the patient had an episode of febrile neutropenia or prolonged grade 4 neutropenia. Treatment was recycled every 28 days. RESULTS: Sixty-one patients completed a median of five cycles, and 60 patients were assessable for response. Major responses were seen in 29 patients (48%; 95% confidence intervals, 35 to 61), which included seven complete responses (12%). Comparable response rates were seen for patients with adenocarcinoma (46%) and those with squamous carcinoma (50%), and for patients with metastatic disease (22 of 46 patients; 48%) and those with locally advanced disease (seven of 14 patients; 50%). A significantly higher complete response rate was observed in patients with squamous carcinoma (20%) compared with those with adenocarcinoma (3%; chi2 P=.04). The median duration of response was 5.7 months (range, 1 to 18.6 months). Median survival was 10.8 months (range, 1.5 to 25 months). Toxicity was severe but manageable with dose attenuation, and included 18% of patients with grade 3 neurologic toxicity. Twenty-eight patients (46%) required a dose attenuation for toxicity, and 42 of 275 treatment cycles (15%) required a dose attenuation. Twenty-nine patients (48%) required hospitalization for toxicity, which included 11 patients for neutropenic fever (18%). There were no treatment-related deaths. CONCLUSION: The combination of paclitaxel, cisplatin, and 5-FU has substantial antitumor activity in metastatic esophageal carcinoma, with a remarkable complete response rate noted in patients with squamous carcinoma. Paclitaxel is an important new agent in the treatment of esophageal carcinoma, and further evaluation of this agent in combination chemotherapy is warranted. Given the toxicity associated with the current regimen, the optimal dose and schedule of paclitaxel in combination chemotherapy remain to be established.
Board review courses for critical care medicine.
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The atrophic variant of dermatofibrosarcoma protuberans in childhood: a report of six cases.
Dermatofibrosarcoma protuberans (DFSP) is typically diagnosed during early adult life at a tumoral stage. It occurs only rarely in children. We report six childhood cases of DFSP which presented initially with the misleading clinical appearance of atrophic plaques, and we review over 140 cases of DFSP in childhood. As compared with adult forms, DFSP in children does not show distinctive features except for a tendency for acral localization. The diagnosis is difficult because of the slow course of the lesions, which present initially as apparently benign atrophic morphoeaor keloid-like plaques. We believe that DFSP in childhood is probably under-estimated, as a significant proportion of patients diagnosed as young adults had an onset several years earlier. Better knowledge of the initial appearance is important for making an early diagnosis and for an easier surgical treatment.
A clinical study of the relationship between silicone breast implants and connective tissue disease.
OBJECTIVE: This study was a blinded, concurrent assessment of a historical cohort derived from a provincial registry (1978 to 1986) of breast implant recipients (cosmetic, not reconstructive) and controls (other cosmetic surgery) to test the hypothesis that connective tissue disease (CTD) is increased in breast implant recipients. METHODS: Women who underwent breast implant or other cosmetic surgery during the interval from 1978 to 1986 were contacted confidentially by Alberta Health and asked to participate in the study. Those willing to participate completed an extensive questionnaire and supplied a blood sample, subsequent to which all surgical records were reviewed to confirm implant type(s) or cosmetic surgery(ies). All participants with any suggestion of rheumatic disease were assessed blindly by a rheumatologist for CTD. RESULTS: One thousand five hundred seventy-six breast implant recipients were recruited, including 1112 who had received silicone gel-filled implants (> 13,500 person yrs exposure). Seven hundred twenty-six controls were recruited. Prevalence rates adjusted for sex and age for rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and Sjögren's syndrome (the principal targeted conditions) were consistent with published reports for Caucasian women. While breast implant recipients self-reported significantly greater rates of symptoms than controls, post-surgical diagnoses of the principal targeted conditions did not indicate an increased incidence of typical or atypical CTD. CONCLUSION: The results of the study do not support the hypothesis that silicone gel-filled implants induce or promote CTD.
Five-year follow-up of treated patients with glaucoma using resolution perimetry.
PURPOSE: The authors describe high-pass resolution perimetry findings during the first five years of antiglaucoma treatment. PATIENTS AND METHODS: Thirty-seven patients were examined six times, once a year for five years, with best corrected visual acuity, applanation tonometry, slitlamp examination, funduscopy, and high-pass resolution perimetry. Twenty-nine of these were treated for glaucoma and eight followed for ocular hypertension without treatment. RESULTS: The resolution thresholds in the treated group improved during the first two years and deteriorated after that back to baseline level. Regarding individual patients, the visual fields were improved in 4, unchanged in 16, and deteriorated in 13 of the 29 treated glaucoma patients at the end of the study period. CONCLUSIONS: Resolution visual fields showed initial improvement and subsequent deterioration in treated patients with early glaucoma. The conventional therapy, aiming at reducing intraocular pressure, appeared to postpone visual field decay for at least five years in about 50% of the patients.
Psychological effects of sexual harassment, appraisal of harassment, and organizational climate among U.S. Army soldiers.
This study examines the effects of three types of unwanted sexual experiences in the workplace on the psychological well-being of male and female U.S. Army soldiers, and the mediating or moderating roles of appraisal of sexual harassment, organizational climate, and the sociodemographic profile of victims. A survey was administered to 1,060 male soldiers and 305 female soldiers between May and July, 1995, at three Army posts in the United States. Unwanted sexual experiences were found to be significant predictors of psychological symptoms for male and female soldiers. Certain aspects of organizational climate and appraisal of sexual harassment were also significant predictors of psychological symptoms.
The role of liver transplantation in the subacute trauma patients.
Two case reports are presented involving complex liver traumas requiring the need for liver transplantation. Both of these patients were designated unsalvageable until the transplant team was consulted. It is imperative that surgeons involved with complex hepatic trauma not give up hope and include these patients as potential liver recipients when irreversible liver failure occurs.