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Biomedical subjects

M J Edwards

Publications and source records attributed to M J Edwards.

At least 91 records · Page 5Linked to original sources
PubMed1999

Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of sonography in our algorithm when differentiating patients with blunt abdominal trauma who need immediate surgery from patients who would benefit from further diagnostic workup or who need no treatment. SUBJECTS AND METHODS: We performed abdominal sonography as the primary screening tool in 1671 consecutive patients in our prospective study. Radiologists performed sonography in the trauma room within minutes of the arrival of each patient. Hemodynamic instability in conjunction with positive sonographic findings led to emergency laparotomy. Otherwise, positive sonographic findings warranted additional diagnostic tests. Observing free fluid or organ injury caused us to categorize sonographic findings as positive. RESULTS: Sonography correctly identified all patients requiring emergency laparotomy. No inconclusive laparotomies were performed in this group. The sensitivity of sonography for revealing intraabdominal injury was 88%, the specificity was 100%, and the accuracy was 99%. In 132 patients (8%), abdominal CT was performed. CT revealed relevant posttraumatic abnormalities in 61% of all patients. Four hundred seventy patients with negative sonographic findings were discharged approximately 12 hr after admission; two of these patients (0.4%) were mistakenly discharged. Trauma scores did not influence the efficacy of sonography. CONCLUSION: Our algorithm that uses sonography as the primary diagnostic tool provides accurate, fast, cost-effective, and noninvasive initial management of patients with blunt abdominal trauma. Our test characteristics were excellent indicators of the need for emergency laparotomy. Sonography also achieves high values in revealing relevant injury. Our algorithm produced medically satisfactory and economically prudent management of patients with blunt abdominal trauma.

Abdomen↗
PubMed1999

Management issues regarding hepatic adenomatosis.

Hepatic adenomatosis is a rare disease defined by multiple hepatic adenomas. There is controversy with regard to the optimal treatment for this disease because the potential for intraperitoneal hemorrhage or malignant transformation of the tumors is difficult to estimate. Furthermore, the technical difficulties of complete resection of all adenomas present unique operative challenges. We report experience with two patients and reviewed all reported cases from 1977. We define hepatic adenomatosis as five or more hepatic adenomas not associated with a medical history of glycogen storage disease, anabolic steroid use, or oral contraceptive use. The incidence of hepatic adenomatosis was preponderate among women [20 of 32 patients (63%)]. Thirteen of 32 patients (41%) had intratumoral bleeding, including four patients with intraperitoneal hemorrhage. Ten of 13 patients (77%) with intratumoral bleeding complained of abdominal pain; overall, 19 of 32 patients (59%) had abdominal pain. Twelve patients underwent hepatic resection, 6 patients underwent liver transplantation with no reported mortality, and 14 patients had no surgical treatment. Hepatocellular carcinoma was histologically confirmed in 2 of 32 patients (6%). Larger symptomatic adenomas exposed to liver surface have a bleeding propensity and should be surgically resected. Routine biopsy of other small nodules suspected as adenomas is recommended for definitive diagnosis.

Adenoma↗
PubMed1999

Providing psychological support to cancer patients.

Nurses may lack the confidence to deal with the psychological problems of patients with cancer. A nurse specialist in psychological support can help staff improve patient assessment. The specialist nurse can also undertake skilled psychological interventions.

Humans↗
PubMed1999

Primary squamous cell carcinoma of the breast presenting as a breast abscess.

Primary squamous cell carcinoma (SCC) of the breast is a very rare neoplasm, with only 75 cases reported in the English literature. Herein, we report four new cases and discuss the diagnostic and therapeutic challenges of this unusual tumor in a retrospective review of all cases of SCC of the breast at our institution from 1990 to 1998. Four patients with breast SCC were identified, with a mean age of 70 years. Two patients with "pure" SCC (no features of ductal carcinoma) were initially treated for breast abscess. Two other patients with features of both SCC and ductal carcinoma had skin erythema associated with an underlying mass, and infectious etiology was considered in each case. Mean tumor size was 4.9 cm. Both patients with pure SCC underwent extensive evaluation for primary tumors at other sites. Two patients developed early systemic metastasis. SCC of the breast is often diagnosed at an advanced stage and may be confused with breast abscess. For this reason, breast biopsy should be considered in cases of breast abscess. Treatment of primary SCC of the breast is similar to that of more common types of breast cancer (i.e., breast conservation is possible and lymph node dissection is recommended). Because metastasis to the breast from other primary tumor sites has been reported (lung, cervix, skin, and esophagus), patients with pure SCC should undergo evaluation to exclude this possibility.

Abscess↗
PubMed1998

Teratogen update: gestational effects of maternal hyperthermia due to febrile illnesses and resultant patterns of defects in humans.

This review has covered the pertinent literature concerning the teratogenic effects of hyperthermia in man and experimental animals. This is the first teratogen that was initially discovered in animals and then subsequently found to be a cause for concern in humans when similar patterns of defects were observed. Hyperthermia is a physical agent with a dose-response curve for abortions and malformations, but these effects can be mitigated in some circumstances by the heat shock response (HSR). We have reviewed the known functions of HSR and provided some insight into why embryos have some protection following an initial dose of heat, if it is sufficient to initiate the response. Thus, by reviewing the effects of hyperthermia in experimental animals, as well as malformative and protective mechanisms of teratogenesis, we have attempted to understand the effects of human hyperthermia teratogenesis.

Animals↗
PubMed1998

Chemokine involvement in hepatic ischemia/reperfusion injury in mice: roles for macrophage inflammatory protein-2 and Kupffer cells.

Hepatic injury induced by ischemia and reperfusion is an important clinical problem after liver resection or transplantation. Neutrophils are known to mediate the organ injury, but the precise mechanisms leading to hepatic neutrophil recruitment are undefined. Two CXC chemokines, macrophage inflammatory protein-2 (MIP-2) and KC, are potently chemotactic for neutrophils in vitro and have been reported to be involved in neutrophil-dependent inflammatory tissue injury. The objective of the present study was to determine the roles of MIP-2 and KC in the induction of hepatic ischemia/reperfusion injury. C57BL/6 mice were subjected to 90 minutes of partial hepatic ischemia followed by reperfusion. Hepatic injury was associated with neutrophil sequestration, edema, and elevated serum levels of hepatic transaminases. The expression of MIP-2 messenger RNA (mRNA) was induced within 3 hours after reperfusion, before any detectable increase in neutrophil accumulation, and was also increased to a greater extent in the ischemic lobe after 9 hours of reperfusion. These data suggest that MIP-2 may be involved in the initial recruitment of neutrophils to the ischemic lobe. In contrast, KC mRNA expression was not increased after 3 hours of reperfusion but after 9 hours increased equivalently in both ischemic and nonischemic lobes, suggesting a more generalized role in neutrophil recruitment. Neutralization of MIP-2 or KC resulted in significant decreases in hepatic neutrophil accumulation, edema, and hepatocellular injury. These data suggest that the local expression of MIP-2 and KC are important mediators involved in neutrophil-dependent hepatic injury induced by ischemia and reperfusion in mice.

Alanine Transaminase↗
PubMed1998

Chemokine involvement in hepatic ischemia/reperfusion injury in mice: roles for macrophage inflammatory protein-2 and KC.

Hepatic injury induced by ischemia and reperfusion is an important clinical problem after liver resection or transplantation. Neutrophils are known to mediate the organ injury, but the precise mechanisms leading to hepatic neutrophil recruitment are undefined. Two CXC chemokines, macrophage inflammatory protein-2 (MIP-2) and KC, are potently chemotactic for neutrophils in vitro and have been reported to be involved in neutrophil-dependent inflammatory tissue injury. The objective of the present study was to determine the roles of MIP-2 and KC in the induction of hepatic ischemia/reperfusion injury. C57BL/6 mice were subjected to 90 minutes of partial hepatic ischemia followed by reperfusion. Hepatic injury was associated with neutrophil sequestration, edema, and elevated serum levels of hepatic transaminases. The expression of MIP-2 messenger RNA (mRNA) was induced within 3 hours after reperfusion, before any detectable increase in neutrophil accumulation, and was also increased to a greater extent in the ischemic lobe after 9 hours of reperfusion. These data suggest that MIP-2 may be involved in the initial recruitment of neutrophils to the ischemic lobe. In contrast, KC mRNA expression was not increased after 3 hours of reperfusion but after 9 hours increased equivalently in both ischemic and non-ischemic lobes, suggesting a more generalized role in neutrophil recruitment. Neutralization of MIP-2 or KC resulted in significant decreases in hepatic neutrophil accumulation, edema, and hepatocellular injury. These data suggest that the local expression of MIP-2 and KC are important mediators involved in neutrophil-dependent hepatic injury induced by ischemia and reperfusion in mice.

Animals↗
PubMed1998

Choice of anaesthetic and healthcare facility for third molar surgery.

A prospective investigation was carried out to find out which factors affected the choice of anaesthetic for 444 consecutive patients (153 male, 291 female, age range 15-85) listed for extraction of third molars. Two hundred and seventy-two were listed for treatment under general anaesthesia, 120 (44%) as inpatients and 152 (60%) as day cases. The remaining 144 (32%) patients were to be treated under local anaesthesia and 28 (6%) with additional intravenous sedation. Logistic regression analysis showed that difficulty of surgery, patients' anxiety, patients' preferences, medical history, and number of teeth to be removed were important predictors of choice of anaesthetic. From an anaesthetist's perspective, many more patients should have been treated under local anaesthesia with intravenous sedation and fewer should have been listed for inpatient extraction under general anaesthesia.

Adolescent↗
PubMed1998

Ultrasound-induced temperature increase in the guinea-pig fetal brain in vitro.

The temperature of the brain of fetal guinea pigs was measured in vitro during exposure to an unscanned beam of pulsed ultrasound at intensity ISPTA 2.8 W/cm2. A mean temperature increase of 5.1 degrees C recorded after 2 min of insonation confirms results of an earlier similar study. The water-bath exposure system provided enhanced cooling of superficial tissue by acoustic streaming. When the scalp was removed, the ultrasound-induced temperature increase was substantially reduced (by 35%) due to cooling through radiation force-induced bulk fluid streaming along the direction of propagation in the water bath. The measured temperature increase in guinea pig fetal brain correlated with a modified cranial thermal index.

Analysis of Variance↗
PubMed1998

Ultrasound-induced temperature increase in guinea-pig fetal brain in utero: third-trimester gestation.

Temperature increase was measured at various depths in the brain of living fetal guinea pigs during in utero exposure to unscanned pulsed ultrasound at ISPTA 2.8 W/cm2. Mean temperature increases of 4.9 degrees C close to parietal bone and 1.2 degrees C in the midbrain were recorded after 2-min exposures. When exposures were repeated on the same sites in each fetus after death, the corresponding mean temperature increases were 4.9 degrees C and 1.3 degrees C, respectively. Cerebral blood perfusion had little cooling effect on ultrasound-induced heating in the guinea pig fetus of 57-61 days gestational age.

Animals↗
PubMed1998

In vivo heating of the guinea-pig fetal brain by pulsed ultrasound and estimates of thermal index.

Temperature was measured in the brain in live near-term fetal guinea pigs (62-66 d gestational age), during in utero exposure to a fixed beam of pulsed ultrasound at intensity ISPTA 2.82 W/cm2. Mean temperature increases of 4.3 degrees C close to parietal bone and 1.1 degrees C in the mid-brain were recorded after 2-min exposures. These values were lower (12%) than those obtained for ultrasound-induced heating near the bone in dead fetuses insonated in utero. A significant cooling effect of vascular perfusion was observed only when guinea pig fetuses reached late gestation, near term, when the cerebral vessels were well developed. The estimated value for the thermal index (TIB), as used in AIUM/NEMA output display standard, underestimated the measured temperature increase at the bone-brain interface. The ratio of measured temperature to the TIB is 1.3. A modification of the cranial thermal index provided a more reasonable, conservative, estimate of the temperature increase at a biologically significant point of interest at the brain-bone interface.

Animals↗
PubMed1998

Effects of pulsed ultrasound on sphenoid bone temperature and the heart rate in guinea-pig foetuses.

Temperature increase induced by exposure to unscanned pulsed ultrasound at an intensity (I(SPTA)) 2.82 W/cm2 was measured in the brain adjacent to the sphenoid bone of foetal guinea-pigs in late gestation under in vitro and in vivo (in utero) conditions. After 120 s exposure a mean temperature increase of 2.6 degrees C was measured in vitro. Removal of the overlying parietal bones increased this value to 5.2 degrees C. Mean temperature increases at the sphenoid bone recorded in utero were 1.5 degrees C live and 2.0 degrees C post mortem. Measurement of foetal ECG showed that ultrasound-induced heating of the hypothalamic region did not significantly alter foetal heart rate.

Animals↗
PubMed1998

Vitelline envelope genes of the yellow fever mosquito, Aedes aegypti.

Vitelline envelope genes from the mosquito Aedes aegypti were analyzed with respect to their DNA sequences, genomic representation, temporal and spatial expression profiles and response to 20-hydroxyecdysone. Genomic clones of three vitelline envelope genes, 15a-1, 15a-2 and 15a-3 were isolated. Southern analysis indicates that all three genes are represented by a single copy in the genome. The deduced amino acid sequences of all three vitelline envelope genes contain a conserved region of 46 residues that overlaps with a region that is conserved in four Drosophila melanogaster vitelline envelope genes. DNA was sequenced flanking the 15a-1, 15a-2 and 15a-3 coding regions. A 360 bp sequence 5' of the 15a-2 coding region was identified with 72% identity to a sequence upstream of the Ae. aegypti VgA1 vitellogenin gene. The temporal patterns of 15a-1, 15a-2 and 15a-3 expression, as determined by Northern analysis, were similar. The spatial patterns of expression, as determined by whole-mount in situ hybridization, differed between the three genes. 15a-1 and 15a-3 were only expressed in the middle and posterior regions of the follicle, while 15a-2 was also expressed at the anterior region. Vitelline envelope gene expression was higher in ovaries that were dissected at 0, 2 and 10 h following a blood meal and then incubated in vitro for 10 h in medium containing 10(-5) M 20-hydroxyecdysone, compared to ovaries that were incubated without hormone.

Aedes↗
PubMed1998

Surgical oncology.

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Biomarkers, Tumor↗
PubMed1998

OA1 mutations and deletions in X-linked ocular albinism.

X-linked ocular albinism (OA1), Nettleship-Falls type, is characterized by decreased ocular pigmentation, foveal hypoplasia, nystagmus, photodysphoria, and reduced visual acuity. Affected males usually demonstrate melanin macroglobules on skin biopsy. We now report results of deletion and mutation screening of the full-length OA1 gene in 29 unrelated North American and Australian X-linked ocular albinism (OA) probands, including five with additional, nonocular phenotypic abnormalities (Schnur et al. 1994). We detected 13 intragenic gene deletions, including 3 of exon 1, 2 of exon 2, 2 of exon 4, and 6 others, which span exons 2-8. Eight new missense mutations were identified, which cluster within exons 1, 2, 3, and 6 in conserved and/or putative transmembrane domains of the protein. There was also a splice acceptor-site mutation, a nonsense mutation, a single base deletion, and a previously reported 17-bp exon 1 deletion. All patients with nonocular phenotypic abnormalities had detectable mutations. In summary, 26 (approximately 90%) of 29 probands had detectable alterations of OA1, thus confirming that OA1 is the major locus for X-linked OA.

Albinism, Ocular↗