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Biomedical subjects

M E Baker

Publications and source records attributed to M E Baker.

At least 91 records · Page 5Linked to original sources
PubMed1993

Appearance of oxidized cellulose (Surgicel) on postoperative CT scans: similarity to postoperative abscess.

OBJECTIVE: Oxidized regenerated cellulose (Surgicel), a sterile knitted fabric that causes thrombus formation because of its physical properties, is frequently used for intraoperative hemostasis. Unlike traditional surgical sponges, it is bioabsorbable and can be left in the surgical bed. On CT scans, the appearance of the retained oxidized cellulose can mimic that of an abscess. The purpose of this study was to describe the appearance of oxidized regenerated cellulose on postoperative CT scans so that an erroneous diagnosis of an abscess can be avoided. MATERIALS AND METHODS: We reviewed the CT examinations of five postoperative patients in whom oxidized regenerated cellulose had been used for surgical hemostasis. Operative reports and surgeons confirmed the use of oxidized cellulose. Four CT scans were abdominal examinations, and one was a head examination. RESULTS: In four cases, CT scans showed focal, linear collections of gas within masses with mixed attenuation in or near the operative site. No air-fluid levels were present. In three patients, cultures of specimens obtained by aspiration were negative for pyogenic organisms. CONCLUSION: Retained oxidized cellulose can mimic an abscess on CT scans. Focal collections of air centrally located within a mass should alert the radiologist that oxidized cellulose may have been placed in the operative site, and an appropriate history should be sought.

Abscess↗
PubMed1993

Contrast material for combined abdominal and pelvic CT: can cost be reduced by increasing the concentration and decreasing the volume?

OBJECTIVE: The purpose of this study was to determine if enhancement provided by a smaller volume of a more concentrated nonionic contrast agent is equivalent to that provided by a larger volume of a less concentrated nonionic agent on dynamic, incremental abdominal and pelvic CT. SUBJECTS AND METHODS: During a 4-month period, 168 patients undergoing dynamic incremental abdominal and pelvic CT received 150 ml iopamidol-300 (45 g iodine). During the following 4 months, 119 patients received 125 ml ioversol-320 (40 g iodine). The same automated injector and scanning parameters were used for both groups. Absolute enhancement of the liver at three levels and of abdominal and pelvic vessels was calculated and analyzed by using Student's t-test. RESULTS: Arterial and venous enhancement in the upper part of the abdomen, at the level of the iliac crest, or in the pelvis was not significantly different with the two contrast agents. Both ioversol and iopamidol provided the same mean enhancement of the hepatic parenchyma at the level of the hepatic veins (45 H) and at the level of the portal vein (49 H). At the level of the gallbladder fossa, enhancement of liver parenchyma with the two contrast agents was significantly different (p = .04): mean enhancement was 45 H for iopamidol and 42 H for ioversol. A retrospective analysis of the liver enhancement profiles from 50 randomly selected patients from each group showed no significant difference in parenchymal enhancement. CONCLUSION: For dynamic abdominal and pelvic CT, no statistically significant difference was found between the mean enhancement of the liver and abdominal vessels after administration of 125 ml of ioversol-320 and that after administration of 150 ml of iopamidol-300. Therefore, 125 ml of ioversol-320 can be used instead of 150 ml of iopamidol-300 without compromising image quality. At current prices, this will result in savings of approximately 18% per patient.

Abdomen↗
PubMed1992

Expansion of the mammalian 3 beta-hydroxysteroid dehydrogenase/plant dihydroflavonol reductase superfamily to include a bacterial cholesterol dehydrogenase, a bacterial UDP-galactose-4-epimerase, and open reading frames in vaccinia virus and fish lymphocystis disease virus.

Mammalian 3 beta-hydroxysteroid dehydrogenase and plant dihydroflavonol reductases are descended from a common ancestor. Here we present evidence that Nocardia cholesterol dehydrogenase, E. coli UDP-galactose-4 epimerase, and open reading frames in vaccinia virus and fish lymphocystis disease virus are homologous to 3 beta-hydroxysteroid dehydrogenase and dihydroflavonol reductase. Analysis of a multiple alignment of these sequences indicates that viral ORFs are most closely related to the mammalian 3 beta-hydroxysteroid dehydrogenases. The ancestral protein of this superfamily is likely to be one that metabolized sugar nucleotides. The sequence similarity between 3 beta-hydroxysteroid dehydrogenase and the viral ORFs is sufficient to suggest that these ORFs have an activity that is similar to 3 beta-hydroxysteroid dehydrogenase or cholesterol dehydrogenase, although the putative substrates are not yet known.

3-Hydroxysteroid Dehydrogenases↗
PubMed1992

An endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm for the management of pancreatic pseudocysts.

In the treatment of pancreatic pseudocysts, percutaneous and endoscopic drainage have, in certain cases, become alternatives to surgery. However, each treatment modality carries risks of complications and recurrences that may be minimized by the appropriate allocation of therapy. This article proposes the use of an endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm as a means to allocate pseudocyst therapy based on the findings of pancreatic duct obstruction or pseudocyst communication. To evaluate this algorithm, the records of a series of patients with pancreatic pseudocysts seen at Duke University Medical Center from 1984 to 1990 were reviewed. Of 102 patients, 73 had symptomatic pseudocysts that required treatment. Forty of the 69 elective interventions were preceded by ERCPs and retrospectively applied to the algorithm. The number of adverse outcomes (treatment failures + complications) of the group that followed the algorithm was 3 of 26 (12%), while the number of adverse outcomes of the group that did not follow the algorithm was 6 of 14 (43%) (p less than 0.04 by Fisher's exact test). These two subgroups were similar in all other characteristics examined. Therefore, this ERCP-based algorithm may be used to allocate pseudocyst treatment; however, a prospective trial is necessary to prove its efficacy.

Algorithms↗
PubMed1992

Membrane transport proteins: implications of sequence comparisons.

Analyses of the sequences and structures of many transport proteins that differ in substrate specificity, direction of transport and mechanism of transport suggest that they form a family of related proteins. Their sequence similarities imply a common mechanism of action. This hypothesis provides an objective basis for examining their mechanisms of action and relationships to other transporters.

Amino Acid Sequence↗
PubMed1992

Progestins stimulate the differentiation of 3T3-L1 preadipocytes.

The effect of progesterone on the differentiation of the 3T3-L1 preadipocytes was investigated and compared with other sex steroids (estradiol and testosterone), with cortisol, with the synthetic progestin R5020 and with the progestin/glucocorticoid antagonist RU38486. At 10(-8) M, progesterone stimulated the activity of glycerol-3-phosphate dehydrogenase and triglyceride deposition. Progesterone, R5020, cortisol, and RU38486 increased triglycerides about 2-fold at 10(-7) M. Only minimal effects were observed with testosterone and estradiol even at 10(-6) M. When the cells were cultured in presence of 10(-5) M metyrapone the effect of progesterone was unchanged, suggesting that the progesterone was not metabolized to a glucocorticoid. Progesterone, R5020 and RU38486 competed efficiently with [3H]dexamethasone for the glucocorticoid receptor in 3T3-L1 cytosol. These results indicate a significant, reproducible dose-dependent effect of progestins on differentiation of the preadipocytes, which appears to be mediated via the glucocorticoid receptor.

3T3 Cells↗
PubMed1992

Inhibition of Streptomyces hydrogenans 3 alpha,20 beta-hydroxysteroid dehydrogenase by licorice-derived compounds and crystallization of an enzyme-cofactor-inhibitor complex.

Streptomyces hydrogenans 3 alpha,20 beta-hydroxysteroid dehydrogenase reduces the C20 ketone on glucocorticoids and progestins. We find that two licorice-derived compounds, glycyrrhizic acid and carbenoxolone, inhibit this enzyme with microM Kis. Inhibition is competitive, indicating that these compounds are binding at or close to the catalytic site. Carbenoxolone's high aqueous solubility and affinity for 3 alpha,20 beta-hydroxysteroid dehydrogenase enabled us to prepare crystals of a carbenoxolone-NADH-enzyme ternary complex, which preliminary X-ray analysis indicates has a crystal structure that is significantly different from that of the 3 alpha,20 beta-hydroxysteroid dehydrogenase-NADH complex. A comparison of the tertiary structures of these two complexes should prove useful in understanding this enzyme's catalytic mechanism, as well as those of two homologous enzymes, mammalian 11 beta-hydroxysteroid dehydrogenase and 15-hydroxyprostaglandin dehydrogenase that also are inhibited by carbenoxolone.

Binding Sites↗
PubMed1992

Evolution of regulation of steroid-mediated intercellular communication in vertebrates: insights from flavonoids, signals that mediate plant-rhizobia symbiosis.

Various flavonoids, such as genistein, luteolin, and coumestrol, have actions in mammals that are mediated by binding either to classical estrogen receptors or to type II receptors, which also bind estrogen. These actions are of intense interest because they may be the basis for the protective actions of plants against certain cancers, such as breast cancer. The biological activity of flavonoids in mammals raises some questions. Is the hormonal action of flavonoids "an accident" derived from their phenolic groups and general hydrophobicity, which gives them some properties in common with estrogens? Or do flavonoids regulate gene transcription in other organisms? And, if so, is there a connection between their actions in these organisms and in mammals? Some answers to these questions are provided by the actions of plant-derived flavonoids in regulating gene transcription in rhizobia, bacteria that form nitrogen-fixing nodules in the roots of legumes, which has several interesting similarities with steroid-mediated actions in vertebrates. First, there is specificity in the actions of flavonoids in rhizobia; oxidation or reduction of the flavonoid or removal of a hydroxyl group can alter its biological activity. Moreover, some flavonoids are anti-inducers functioning like steroid antagonists to negate the actions of inducers. Also there are sequence similarities between various steroid metabolizing enzymes and proteins found in rhizobia, which indicates that these proteins are derived from a common ancestor. For example, 17 beta-hydroxysteroid dehydrogenase, which catalyzes the interconversion of the alcohol and ketone a C17 on estrogens and androgens, 11 beta-hydroxysteroid dehydrogenase, which catalyzes the interconversion of the alcohol and ketone at C11 of glucocorticoids, and 3 alpha,20 beta-hydroxysteroid dehydrogenase, which catalyzes the interconversion of the alcohol and ketone at C20 of corticosteroids, are homologs of proteins found in rhizobia. Thus, the binding of flavonoids to vertebrate proteins may represent an evolutionary linkage between the actions of steroids in mammals and communication between plants and rhizobia.

Animals↗
PubMed1992

Sex hormone-binding globulin, androgen-binding protein, and vitamin K-dependent protein S are homologous to laminin A, merosin, and Drosophila crumbs protein.

Androgen-binding protein (ABP) and sex hormone-binding globulin (SHBG) are extracellular steroid-binding proteins that are homologous to the COOH-terminal domain of vitamin K-dependent protein S, a protein important in blood clotting. We find that the sequences of ABP, SHBG, and protein S are also similar to two basement membrane proteins, laminin and merosin, and to an integral membrane protein, Drosophila crumbs protein. These latter three proteins have important roles in regulating differentiation and development. The sequence similarity corresponds to the G domain of laminin A chain, which binds heparin and type IV collagen. Analysis of a multiple alignment of these proteins reveals one well-conserved segment corresponding to the part of SHBG that binds to its membrane receptor and another corresponding to the part of protein S that binds to C4b-binding protein. The similarities suggest that ABP, SHBG, and protein S may also have functions related to that of laminin and merosin.

Amino Acid Sequence↗
PubMed1992

Mechanisms of major biliary injury during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has become the procedure of choice for surgical removal of the gallbladder. The most significant complication of this new technique is injury to the bile duct. Twelve cases of bile duct injury during laparoscopic cholecystectomy were reviewed. Eight injuries were of a classic type: misidentification of the common duct for the cystic duct, resection of part of the common and hepatic ducts, and associated right hepatic arterial injury. Another injury was similar: clip ligation of the distal common duct with proximal ligation and division of the cystic duct, resulting in biliary obstruction and leakage. Three complications arose from excessive use of cautery or laser in the region of the common duct, resulting in biliary strictures. Evaluation of persistent diffuse abdominal pain led to the recognition of ductal injury in most patients. Ultimately, 10 patients required a Roux-en-Y hepaticojejunostomy to provide adequate biliary drainage. One patient had a successful direct common duct repair, and the remaining patient underwent endoscopic dilatation.

Adult↗
PubMed1992

Effect of brassinolide on gene expression in elongating soybean epicotyls.

We have studied the effect of brassinolide (BR), a plant steroidal lactone, on the expression of auxin-regulated genes in soybean (Glycine max L. cv Williams 82) epicotyls. BR caused up to 4-fold increases in epicotyl length during extended assays at 10(-7)m, in the absence of added auxin. Structurally related steroids failed to induce elongation or to alter the BR effect. Northern blot analysis, using sequences corresponding to auxin-regulated genes as probes, has shown that the molecular mechanism of BR-induced elongation is likely to differ from that of auxin-induced elongation in this system. BR does not rapidly induce members of the GH, SAUR, or JCW auxin-inducible gene families before the onset of elongation. BR enhances SAUR and GH1 transcripts after 18 h but has no effect on JCW1 or GH3 transcripts at any time examined. We have shown by two-dimensional gel analysis of in vitro translated mRNA that a submicromolar concentration of BR alters the pattern of gene expression in elongating soybean epicotyls.

Journal Article↗
PubMed1992

Similarities between legume-rhizobium communication and steroid-mediated intercellular communication in vertebrates.

Regulation of the actions of flavonoids and Nod factors in legume-rhizobia communication has several interesting similarities with that of steroid-mediated actions in vertebrates. Oxidation or reduction of flavonoids and Nod factors modifies their biological activity just as, for example, oxidation of an alcohol at C11 on hydrocortisone regulates its biological activity. Second, some flavonoids are anti-inducers, functioning like steroid antagonists to negate the actions of inducer flavonoids. Amino acid sequence analyses show that human 17 beta-hydroxysteroid dehydrogenase, which catalyzes the interconversion of the alcohol and ketone at C17 on estrogens and androgens, and rat 11 beta-hydroxysteroid dehydrogenase, which catalyzes the interconversion of the alcohol and ketone at C11 of glucocorticoids, and Rhizobium meliloti NodG and Bradyrhizobium japonicum. FixR are derived from a common ancestor. Just as steroid-metabolizing enzymes can regulate steroid-mediated gene transcription, enzymes that modify substituents on flavonoids and Nod factors may have a similar role in regulating signalling between legumes and rhizobia. The enzymes that modify flavonoids and Nod factors have not yet been identified. However, NodG and FixR are two likely candidates to have this role in regulating legume-rhizobia signalling.

Amino Acid Sequence↗
PubMed1992

Subxiphoid pericardiotomy in the diagnosis and management of large pericardial effusions associated with malignancy.

To determine the safety, diagnostic value, and clinical outcome of patients with malignancy undergoing subxiphoid pericardiotomy for large pericardial effusions, we prospectively studied 25 consecutive patients with malignancy and new, large pericardial effusions diagnosed by echocardiography. Twenty-two of the 25 operations were done under local anesthesia, and no patient died at surgery. Pericardial fluid cytology revealed malignant cells in 11 patients (44 percent), while tumor was seen in only five (45 percent) of these 11 patients on pathologic examination. The remaining 14 patients showed no evidence of pericardial invasion with tumor. Evidence of intrathoracic disease by CT or MRI scanning, tamponade, a sanguineous pericardial fluid character, and an elevated serum and pericardial fluid lactate dehydrogenase level all were suggestive of malignant invasion of the pericardium. All 25 patients were followed at least 12 months postoperatively. Effusions recurred in three patients (12 percent), and one patient required reoperation. Overall mortality was 72 percent with a 91 percent (10 of 11) mortality for those with malignant effusions and a 57 percent (8 of 14) mortality for those with nonmalignant effusions. Diagnostically, subxiphoid pericardiotomy has little advantage over examination of pericardial fluid alone in this group of patients. Therapeutically, however, it is a low morbidity procedure which is safe and effective in treating patients with malignancy and large pericardial effusions.

Cardiac Tamponade↗
PubMed1992

Malignant biliary obstruction: efficacy of thin-section dynamic CT in determining resectability.

OBJECTIVE: Several authorities advocate the use of preoperative angiography to determine the resectability of pancreatic and periampullary tumors, claiming that CT alone is not sufficiently accurate for this purpose. Our objective was to assess the value of CT in predicting surgical resectability in patients with malignant biliary obstruction. MATERIALS AND METHODS: We performed a retrospective analysis of 380 consecutive cases of malignant biliary obstruction spanning a 4-year period. Most patients (230) were treated nonoperatively. Sixty-seven patients had surgery, pathologic confirmation of malignancy, and preoperative CT scans available for review. The CT scans were assessed for surgical resectability of tumor by an interpreter who did not know the patient's history. RESULTS: Forty-two patients had pancreatic adenocarcinoma, six had ampullary carcinoma, seven had cholangiocarcinoma, and 12 had other malignant neoplasms. Of 47 patients with tumors thought to be unresectable on the basis of CT findings, 42 had tumors that were found to be unresectable at surgery (positive predictive value, 89%). Of 20 patients with tumors thought to be resectable, 16 had tumors that were surgically resectable (positive predictive value, 80%). CT did not show metastases to duodenal lymph nodes (n = 2), portal vein infiltration (n = 1), and small hepatic metastases (n = 1). Visualization of most of these at angiography would not be expected. The CT finding of infiltration of the periarterial fat around the celiac or superior mesenteric arteries was reliable for predicting surgical unresectability. Lymphadenopathy and infiltration of nonperivascular fat planes were less reliable predictors of unresectability. CONCLUSION: Although some findings on CT that suggest unresectability are less reliable than others, the accuracy of CT compares favorably with reports on the accuracy of angiography for assessing tumor resectability in cases of malignant biliary obstruction. The addition of angiography to the examination of patients with potentially resectable lesions is not justified when high-quality, thin-section dynamic CT has been performed.

Adenocarcinoma↗
PubMed1992

CT arterial portography: causes of technical failure and variable liver enhancement.

OBJECTIVE: We studied the causes of technical failure and enhancement variability encountered during CT arterial portography. MATERIALS AND METHODS: CT arterial portograms and digital arteriograms were obtained via the superior mesenteric artery before partial liver resection in 43 patients with malignant tumors. These studies were reviewed for causes of technical failure and variable enhancement. RESULTS: Eleven (26%) of 43 procedures were technical failures. Causes of failure included aortic injection after catheter dislodgement (four), dense hyperenhancement associated with laminar flow in the portal vein produced by rapid venous return from a selective injection into a proximal branch vessel of the superior mesenteric artery (two), premature scanning beginning at the iliac crest (two), reflux into a replaced right hepatic artery (one), hepatic arterial enhancement via the pancreaticoduodenal arcade (one), and portal hypertension (one). Of the 32 remaining studies, 28 showed areas of parenchymal hypoenhancement or hyperenhancement. Causes of variable enhancement included impaired portal vein perfusion from mass effect of the tumor, laminar flow in the portal vein, and focal fatty infiltration. CONCLUSION: Technical failures and enhancement variability are common in CT arterial portography. Factors leading to technical failure include catheter choice and position, portal hypertension, and operator error.

Carcinoma, Hepatocellular↗
PubMed1992

Stent placement for benign pancreatic diseases: correlation between ERCP findings and clinical response.

OBJECTIVE: We performed a study to determine if the appearance of the pancreatic duct on ERCP before and after placement of pancreatic duct stents correlates with the therapeutic response in patients treated for impaired pancreatic drainage. MATERIALS AND METHODS: Findings in 29 consecutive patients with a variety of benign pancreatic diseases in whom pancreatic stents were placed and subsequently removed within a 3-year period were reviewed retrospectively. Early (1-5 days) and late (1-3 months) clinical outcomes after stent placement were assessed. These findings were correlated with a blinded interpretation of ERCP findings (Cambridge criteria were used) before and after stent placement. RESULTS: ERCP findings before stent placement were normal in 10 patients. At the end of stent therapy, ERCP showed changes associated with chronic pancreatitis in all 10; five had focal narrowing at the tip of the stent. Subsequent ERCP studies in five of these 10 patients showed that ductal changes induced by stents diminished after stent removal. Of the 19 patients with abnormal findings on ERCP at the time of stent placement, ERCP at the end of stent therapy showed some improvement in seven patients, no change in eight, and deterioration in four. Changes seen on ERCP had no statistically significant correlation with clinical outcome (p = .36). CONCLUSION: Our findings show that pancreatic duct stents can induce abnormalities on ERCP indicative of chronic pancreatitis. However, diminution of these abnormalities after stent removal in some patients suggests that these changes may be due to edema rather than to fibrosis. Ductal changes seen on ERCP are not a useful guide for determining the degree of response to pancreatic stents.

Cholangiopancreatography, Endoscopic Retrograde↗