Search PubMed⌕ Search

Biomedical subjects

L Ward

Publications and source records attributed to L Ward.

At least 73 records · Page 4Linked to original sources
PubMed1993

Home rules.

Explore the source record for details and available documents.

Activities of Daily Living↗
PubMed1993

Resection-line involvement in gastric cancer: a continuing problem.

Surgeons are aware of the adverse effect that resection-line disease has on anastomotic leakage, perioperative mortality and long-term survival. In an attempt to assess the effect of this knowledge on surgical practice, patients entered into the second British Stomach Cancer Group adjuvant therapy trial were studied. The presence of resection-line disease was compared with the operative stage. Of 555 patients for whom complete data were available, resection-line disease was present in 105 (19 per cent). Of 424 patients undergoing what the surgeon considered to be a potentially curative operation, 55 (13 per cent) had involvement of one or both resection lines, rendering the surgery palliative. Only 9 per cent of patients with stage I-III disease and resection-line involvement survived beyond 5 years, compared with 27 per cent of those with clear lines. Despite knowledge of the adverse effects of resection-line disease, surgeons continue to perform inadequate resections. This demonstrates the need for a more aggressive approach to assessment of resection margins at operation.

Gastrectomy↗
PubMed1993

An epidemiological study of listeriosis complicating a bone marrow transplant.

Following an unrelated-donor bone marrow transplant a six-year-old child with severe aplastic anaemia developed Listeria monocytogenes septicaemia and meningitis. Cook-chill foods consumed during his stay in hospital were found to contain strains of L. monocytogenes and other Listeria species. Whole cell protein SDS-PAGE was performed on all isolates. No food isolates were found that were identical to the patient's strain by this technique or by serotyping. The usefulness of whole cell protein SDS electrophoresis for listeria strain differentiation is discussed.

Anemia, Aplastic↗
PubMed1993

A crossover comparison of progression of chronic renal failure: ketoacids versus amino acids.

Rates of progression of chronic renal failure were compared in patients receiving alternately an amino acid supplement (AA) and a ketoacid supplement (KA) to a very low protein (0.3 g/kg), low phosphorus (7 to 9 mg/kg) diet. The first supplement was randomly chosen. Bias due to carryover effects was minimized by delaying the regression analysis until one month after starting or changing supplements. In order to minimize possible bias caused by initiating the two supplements at differing levels of severity, a multiple crossover design was used (ABA, BAB, ABAB, or BABA) with at least four GFR's in each treatment period (except for three GFR's in one instance). Sixteen patients completed the protocol; five dropped out. Average starting GFR's were nearly identical for the two supplements (15.4 and 15.9 ml/min). For each patient, mean progression on KA was compared with mean progression on AA. Thirteen out of 16 patients progressed more slowly on KA than AA. On the average, progression on KA was significantly slower (95% confidence limits = -0.36 to 0.09 ml/min/month) than on AA (-0.91 to -0.41 ml/min/month; P = 0.024). There was no significant difference in estimated protein intake, phosphate excretion, or mean arterial pressure between KA and AA periods. Serum triglyceride concentration was significantly lower on KA (P = 0.0026). 17-hydroxycorticosteroid excretion was also lower (P = 0.031). We conclude that KA slow progression, relative to AA, independently of protein or phosphorus intake, in patients on this regimen.

Adult↗
PubMed1993

Nonsteroidal antiinflammatory drug desensitization using flurbiprofen (Ansaid)

Nonsteroidal antiinflammatory drug (NSAID) and aspirin reactions remain commonplace. Specific recommendations and standardized approaches to the use of NSAIDs in patients with known hypersensitivity to these agents are evolving. Cross reactivity and sensitization are frequent within this group of agents. The advent of newer synthetic nonsteroidal antiinflammatory drugs may offer a means of lowering reaction rates. Flurbiprofen (Ansaid) is a new NSAID for the treatment of rheumatoid arthritis and osteoarthritis. We report successful flurbiprofen desensitization with incremental oral challenge in a patient using this agent.

Adult↗
PubMed1992

Association of antibody to human immunodeficiency virus type 1 core protein (p24), CD4+ lymphocyte number, and AIDS-free time.

Serum antibody to p24 (anti-p24) and p24 antigen, alone and in combination with CD4+ lymphocyte number, were evaluated as predictors of progression of human immunodeficiency virus type 1 (HIV-1) infection. Two hundred six HIV-1-prevalent seropositive men in the Multi-center AIDS Cohort Study since 1984-1985 were studied cross-sectionally and 84 seroconverters were evaluated longitudinally. Cross-sectional analyses revealed significant associations among titer of anti-p24, CD4+ cell count, disease status (Centers for Disease Control class), and progression to AIDS. A high titer of anti-p24 was associated with lack of p24 antigenemia. Longitudinal studies of seroconverters demonstrated that a low titer of anti-p24, low CD4+ cell count, and detection of HIV-1 p24 antigen are individually strong predictors of AIDS, but only low CD4+ cell count retains its independent predictive value in multivariate analysis of the three markers during the period immediately after infection with HIV-1.

Analysis of Variance↗
PubMed1992

Progression of chronic renal failure on substituting a ketoacid supplement for an amino acid supplement.

Twelve patients with severe chronic renal failure (average initial GFR, 13 mL/min) were monitored for 4 to 23 months while receiving an essential amino acid supplement and were then switched to a ketoacid supplement for 6 to 40 months, while continuously receiving a very low-protein (0.3 g/kg), low-phosphorus (7 to 9 mg/kg) diet. Urinary urea N excretion indicated that actual dietary protein intake averaged 0.46 g/kg. Progression, estimated as the linear regression slope of radioisotopically determined GFR on time, slowed from -0.46 +/- 0.31 (SD) to -0.24 +/- 0.15 mL/min/month (P = 0.029). Serum urea N, creatinine, phosphate, and uric acid rose significantly as GFR fell; blood pressure, plasma lipids, and urinary urea excretion were unchanged. Urinary 17-hydroxy-corticosteroid excretion decreased 18%, but this change was only marginally significant (P = 0.087). There was no change in plasma or urinary cortisol or urinary aldosterone. Viewed in light of previous evidence that progression seldom slows when treatment remains constant, the results suggest that this ketoacid supplement slows progression by approximately half, compared with an essential amino acid supplement, with no change in diet.

17-Hydroxycorticosteroids↗
PubMed1992

[Elementary precautions: past the principles].

Universal precautions assure maximum protection to patients, workers, and visitors in a health care institution. While establishing universal precautions is a laudable goal, the application is onerous and difficult if the administration is not convinced of the necessity of such a project. At Sainte Justine Hospital in Montreal, the administration has rallied around this project. A vast program of consultation was initiated in January 1988. Simultaneously, a team of physicians and nurses proceeded to revise standards of sterilization and disinfectation in the hospital. In the fall of 1988, a multidisciplinary team produced a document, Universal Precautions. The term used in French--elementary precautions--was developed to demonstrate the need to have these precautions in place at all times throughout the institution. A pilot project was initiated on the perinatal unit to assess the new standards. Results are very positive. The guidelines worked and people appreciated the diverse measures of protection available to them. A full description of the pilot project is given along with the operating budget.

Cross Infection↗
PubMed1991

Cholesterol feeding following unilateral nephrectomy in the rat leads to glomerular hypertrophy.

Experimental glomerulosclerosis is associated with hyperlipidaemia and the deposition of lipid in glomeruli. Glomerulosclerosis is typically preceded by glomerular hypertrophy. To investigate a possible pathogenic role of lipids in glomerulosclerosis, glomerular structure and cellular composition were studied in rats fed either a control diet or one supplemented with 4% cholesterol and 1% cholic acid for 21 weeks following unilateral nephrectomy. On the cholesterol diet there were significant increases in glomerular cross-sectional area (13.11 +/- 0.39 x 10(3) vs. 11.13 +/- 0.44 x 10(3) mu 2, p less than 0.01) and mesangial area (1.81 +/- 0.07 x 10(3) vs. 1.50 +/- 0.08 x 10(3) mu 2, p less than 0.02). These changes were significantly correlated with proteinuria, which was significantly greater on the cholesterol diet (mean area under curve for duration of diet = 3.11 +/- 0.38 vs. 1.42 +/- 0.35 g, p less than 0.02). There was a significant increase in glomerular leukocytes on the cholesterol diet (4.10 +/- 0.44 vs 2.86 +/- 0.25 OX-1 positive cells/10(4) mu 2, p less than 0.05). Mesangial foam cells, derived from macrophages, were associated with adhesions to Bowman's capsule. These results demonstrate that hyperlipidaemia exacerbates the development of glomerular hypertrophy and that this may be mediated by factors released during the phagocytosis of lipoprotein deposits by macrophages.

Administration, Oral↗
PubMed1991

Vasoactive intestinal polypeptide-, neurotensin-, substance P-, gastrin-releasing peptide-, calcitonin-, calcitonin gene related peptide-, and somatostatin-like immunoreactivities in human parathyroid glands.

We have found vasoactive intestinal polypeptide (VIP)-, neurotensin-, substance P-, gastrin-releasing peptide-, calcitonin-, calcitonin gene related peptide (CGRP-2)-, and somatostatin-like immunoreactivities in extracts of sporadic human parathyroid adenomas (n = 18). The content of CGRP-2, substance P, and somatostatin in adenomas correlated directly with that of parathyroid hormone. In addition, concentrations of VIP versus substance P and somatostatin versus CGRP-2 in adenomas were directly correlated. Neuropeptide content of parathyroid hyperplasias differed from that of adenomas. VIP was detected in only one of seven parathyroid hyperplasias, and neurotensin was undetectable (0/7), whereas substance P was present in six of seven cases and GRP in five of seven hyperplasias. In hyperplasias, content of substance P correlated directly with that of gastrin-releasing peptide. Peroxidase immunohistochemistry localized VIP-like immunoreactivity to 20% to 50% of both chief and oxyphilic cells and rare clear cells and capillary endothelium in 11 of 12 adenomas studied. Focal staining was present in glandular epithelium of the rim of adjacent normal parathyroid tissue and in two of three normal parathyroid glands removed with thyroid goiters. This staining was both cytoplasmic and apical membrane. By contrast, in adenomas, neurotensin- and substance P-like positivities were confined to scattered (5% to 10%) oxyphilic cells. Cytoplasmic positivity for parathyroid hormone, noted in 30% to 70% of cells in serial sections, confirmed that these tissues were indeed parathyroid glands.

Adenoma↗
PubMed1991

Identification and opsonic activity of immunoglobulins recognizing Streptococcus zooepidemicus antigens in uterine fluids of mares.

A direct ELISA was used to measure immunoglobulin (Ig) isotypes G, Gt, A, and M recognizing Streptococcus zooepidemicus epitopes in uterine lavage fluids collected during the early post ovulatory period. A S. zooepidemicus isolate, used as the plate antigen in this assay, was inoculated into the uteri of 8 mares (3 resistant and 5 susceptible to endometritis) at oestrus prior to ovulation during Oestrous Cycles 1, 3 and 5. Resistant mares aged 2-5 years were nulliparous, with clinically normal reproductive tracts as determined by physical examination, bacteriological culture of the uterus, and endometrial biopsy. Susceptible, pluriparous mares, aged 16-24 years, had histories of endometritis and infertility and had chronic endometrial inflammatory changes detected by uterine biopsy. On Post ovulation Day 3 during Oestrous Cycle 1, on the day of ovulation during Oestrous Cycle 3 and on Post Ovulation Day 5 during Oestrous Cycle 5, uterine swab specimens were obtained for bacteriological culture and the uterus was irrigated with 50 ml sterile physiological saline solution containing tracer amounts of 125I-labelled human serum albumin (HSA). The titre of each Ig isotype was determined and the amount in uterine effluents was calculated from the dilution of the 125I-HSA. Total IgG concentration in uterine effluents was measured by radial immunodiffusion. Uterine fluids, either unheated or heated 30 min at 56 degrees C, were used to opsonize the S. zooepidemicus isolate in an assay of luminol-enhanced neutrophil chemiluminescence (CL). Mean peak CL generated was compared with CL generated by a control serum. Streptococcus zooepidemicus was isolated from 10 of 15 (67%) uterine specimens from susceptible mares.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Polyostotic hyperostosis associated with oviductal tumor in a cockatiel.

A 10-year-old female cockatiel in a thin and depressed condition and with a 1 X 2-cm soft abdominal swelling was hospitalized. Radiography revealed a well-circumscribed mass containing punctate areas of mineralization, displacing the gizzard cranially in the caudodorsal portion of the abdomen. There was bilateral, symmetric, generalized, increased medullary opacity of the radius, ulna, carpometacarpus, femur, tibiotarsus, and tarsometatarsus. These findings were compatible with polyostotic hyperostosis secondary to an estrogen-secreting tumor. Euthanasia and necropsy were requested. A small area of neoplastic cells in the oviduct was identified histologically, but most of the tissue mass consisted of necrotic cellular debris. There was no metastasis. Sagittal secretions of decalcified radiopaque bones revealed up to 60% filling of medullary cavities with bone spicules. Although clinical and radiographic findings were compatible with an estrogen-secreting tumor, osteopetrosis, metastatic neoplasia, hypertrophic osteopathy, and metabolic bone disease were included in the initial differential diagnosis. The absence of metastasis and the confinement of the tumor within the oviduct would have made surgical removal a possible approach to treatment.

Animals↗