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Biomedical subjects

M McKay

Publications and source records attributed to M McKay.

At least 55 records · Page 3Linked to original sources
PubMed1989

Bone metastases in hypernephroma. Frequency of scapular involvement.

A consecutive series of 95 patients with hypernephroma was studied retrospectively after it was clinically suspected that there was a propensity for this tumor to metastasize to the scapula. Fifteen patients (15.8%) have developed scapular metastases which account for 36.6% of all bone metastases in this series, the majority of which required radiotherapy for pain relief. The scapula was a solitary site of bone metastasis in the majority of patients, and, even when associated with other bone lesions, was frequently an isolated site of pain. A comparative series of 40 consecutive patients with breast cancer metastatic to bone was retrospectively studied. Twenty-five percent of these showed scapular metastases but these were all in association with multiple (greater than 3) other bone metastases; none was symptomatic or required treatment. There was a suggestion that hypernephromas spread more often to the ipsilateral scapula, but the trend did not reach statistical significance. Scapular metastasis in hypernephroma is a common and clinically significant problem, sometimes giving a clue to the primary site. The cause for this predilection is not known.

Adult↗
PubMed1989

Vulvodynia. A multifactorial clinical problem.

Symptomatic vulvar burning (vulvodynia) in the absence of abnormal physical findings was long thought to be an unusual psychosomatic gynecologic problem. Within the past decade, however, a number of investigators began to study patients with this frustrating problem. Initial physician insistence on a major role for psychological factors has gradually given way to sophisticated searches for evidence of persistent infectious agents, especially human papillomavirus and Candida. Gynecologists searching for causes and surgical relief of vulvodynia have even reevaluated elements of vulvar anatomy. The purpose of this article is to introduce dermatologists to current perspectives on vulvodynia in the context of the clinical experience of the author, who has been actively involved in the multidisciplinary investigation of this problem since its recognition in the early 1980s. To date, the following five sign-symptom complexes have been identified by the author and recognized by other vulvodynia investigators: (1) vulvar dermatoses, (2) cyclic vulvitis, (3) vulvar papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. A given patient's complaint may be primarily associated with one of these factors, but it is not unusual to see others develop simultaneously or sequentially. Remission or exacerbation of symptoms may occur when treatment for one condition affects the onset of another. It is evident that vulvodynia is a complex diagnosis and that recognition of multiple factors is important to appropriate patient evaluation and management.

Female↗
PubMed1989

Seborrhea, psoriasis and the papulosquamous dermatoses.

Knowledge of the papulosquamous disorders is an important part of the diagnosis of skin diseases in general. Recognition of these commonly encountered cutaneous problems depends upon familiarity with the configuration and distribution of lesions on various parts of the body. Diagnostic tests (such as KOH to rule out tinea) should be performed, and when therapy does not seem to be successful, the diagnosis should be reconsidered with a biopsy and/or dermatologic consultation.

Dermatitis, Seborrheic↗
PubMed1989

Comparison of short and long thumb-spica casts for non-displaced fractures of the carpal scaphoid.

A prospective study was undertaken of fifty-one patients who were randomly assigned to treatment with either a long or a short thumb-spica cast for a non-displaced fracture of the carpal scaphoid. The duration of follow-up was at least until union; the average follow-up was twelve months. Twenty-eight fractures were treated with a long thumb-spica cast and twenty-three, with a short thumb-spica cast. The hands that initially were treated with a long thumb-spica cast were placed in a short thumb-spica cast after six weeks. Fractures that initially were treated with a long thumb-spica cast united at an average of 9.5 weeks and those that were maintained in a short thumb-spica cast, at an average of 12.7 weeks. There were no non-unions and two delayed unions in the fractures that initially were treated with a long thumb-spica cast, compared with two non-unions and six delayed unions in those that had only a short thumb-spica cast. Fractures of the proximal or middle third of the carpal scaphoid had a significantly shorter time to union when they were treated initially in a long thumb-spica cast. Fractures of the distal third did well regardless of the type of immobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Epitopes recognized by human T cells map within the conserved part of the GP190 of P. falciparum.

In a study aimed at developing a vaccine against the asexual blood stages of Plasmodium falciparum, two T cell epitopes were identified within a nonpolymorphic region of gp190 of Plasmodium falciparum merozoites. The two epitopes, which were revealed by deletion analysis, stimulated human T cell clones. Peptides containing sequences of the epitopes stimulated the cloned T cells and peripheral blood mononuclear cells (PBMC) from malaria-infected individuals. Moreover, the T cell clones responded to 11 different Plasmodium falciparum isolates in culture, showing that the epitopes are recognized in native parasites.

Amino Acid Sequence↗
PubMed1988

Cutaneous manifestations of candidiasis.

Candida is identified microscopically by the observation of hyphae, linear chains of asexually budding yeast. Since these structures do not grow extensively through the stratum corneum, cutaneous samples may require Gram stain for identification. Since Candida can colonize normal tissue and also be a culture contaminant, clinicians should consider predisposing factors and clinical presentation when making a diagnosis of candidiasis. Predisposing cutaneous factors for candidiasis include occlusion, maceration, and altered barrier function. The hallmarks of Candida infection are bright erythema, fragile papulopustules, and satellite lesions. Cutaneous and mucous membrane candidiasis may differ in appearance, and sexual transmission should be considered. Treatment usually involves a topical or oral anticandidal agent, such as an imidazole. Although implicated as a predisposing factor to candidiasis, mild topical steroids can be used as short-term adjuvant treatment of these infections; when used responsibly, steroids provide antiinflammatory effects that speed relief of patient discomfort.

Anti-Inflammatory Agents↗
PubMed1988

Monitoring for central apnoea in infancy--limitations of single channel recordings.

Apparent central apnoea (absent breathing movements) detected by monitoring movement of the thoracic wall was compared with simultaneous detection by abdominal wall movement. Eighteen infants provided one or more 24 hour recording of heart rate (electrocardiography), thoracic respiration (transthoracic impedance), and abdominal wall movement (pressure sensitive capsule distortion). Detection of true apnoea, recognition of artefact, and measurement of the duration of true apnoea were all improved when two channels of respiratory monitoring were used in combination. We recommend that any study purporting to observe breathing patterns by indirect recording of respiratory movement will be more reliable if more than one channel of respiratory movements is recorded simultaneously. Further, in infants no estimation of duration of central apnoea can be made on the basis of either a transthoracic impedance record alone or an abdominal wall movement sensor alone. Comparison of findings among studies using different single channel recordings are unlikely to be meaningful.

Electrocardiography↗
PubMed1988

Trigeminal trophic syndrome.

Trigeminal trophic syndrome is an unusual condition also known as trigeminal neurotrophic ulceration or trigeminal neuropathy with nasal ulceration. The diagnosis is suggested when ulceration of the face, especially of the ala nasi, occurs in a dermatome of the trigeminal nerve that has been rendered anesthetic by a surgical or other process involving the trigeminal nerve or its central sensory connections. A history of paresthesias and self-induced trauma to the area further support the diagnosis. Neurological deficits causing trigeminal trophic syndrome may result from surgical trigeminal ablation, vascular disorders and infarction of the brainstem, acoustic neuroma, postencephalitic parkinsonism, and syringobulbia. The following etiologies of nasal ulceration should be excluded: postsurgical herpetic reactivation and ulceration, syphilis, leishmaniasis, leprous trigeminal neuritis, yaws, blastomycosis, paracoccidioidomycosis, lethal midline granuloma, pyoderma gangrenosum, Wegener's granulomatosis, and basal cell carcinoma. In the case reported here, the diagnosis of TTS was made primarily as a result of previous experience with the syndrome, underscoring the importance of physician recognition of this unusual disorder.

Cerebrovascular Disorders↗
PubMed1988

Subsets of vulvodynia.

The frustrated patient with vulvar "burning" seldom has grossly abnormal physical findings, and the clinical significance and prognosis of vulvodynia have eluded both gynecologists and dermatologists. Evaluation of the physical findings on initial and follow-up visits of such patients during various treatment protocols has revealed distinct subsets of vulvodynia. In one series of 52 patients at the Emory Clinic, the following subsets were identified in decreasing order of frequency: (1) vulvar dermatoses, (2) cyclic candidiasis, (3) squamous papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. These subsets may occur alone, simultaneously or sequentially; treatment for one condition may affect the onset of another. Vulvodynia may have multiple causes; use of the term for a patient's problem should prompt a thorough diagnostic evaluation. Although the subsets are not entirely exclusive of one another, each is identified by an improvement with specific therapeutic modalities. The recognition of multiple factors in vulvodynia is important to appropriate patient evaluation and management.

Adult↗
PubMed1986

'Near miss' sudden infant death and obstructive apnoea.

A 4 month old girl presented with a 'near miss' sudden infant death episode for which no cause was found. Obstructive sleep apnoea syndrome subsequently developed. All symptoms ceased after adenoidectomy at age 9 months.

Adenoidectomy↗
PubMed1986

Evidence that prostacyclin modulates the vascular actions of calcium in man.

Increases in extracellular calcium (Ca++) can alter vascular tone, and thus may result in increased blood pressure (Bp) and reduced renal blood flow (RBF). Ca++ can stimulate prostaglandin E2 (PGE2) and/or prostacyclin (PGI2) release in vitro, which may modulate Ca++ vascular effects. However, in man, the effect of Ca++ on PG release is not known. To study this, 14 volunteers received low-dose (2 mg/kg Ca++ gluconate) or high-dose (8 mg/kg) Ca++ infusions. The low-dose Ca++ infusion did not alter systemic or renal hemodynamics, but selectively stimulated PGI2, as reflected by the stable metabolite 6-keto-PGF1 alpha in urine (159 +/- 21-244 +/- 30 ng/g creatinine, P less than 0.02). The same Ca++ infusion given during cyclooxygenase blockade with indomethacin or ibuprofen was not associated with a rise in PGI2 and produced a rise in Bp and fall in RBF. However, sulindac, reported to be a weaker renal PG inhibitor, did not prevent the Ca++ -induced PGI2 stimulation (129 +/- 33-283 +/- 90, P less than 0.02), and RBF was maintained despite similar increases in Bp. The high-dose Ca++ infusion produced an increase in mean Bp without a change in cardiac output, and stimulated urinary 6-keto-PGF1 alpha to values greater than that produced by the 2-mg/kg Ca++ dose (330 +/- 45 vs. 244 +/- 30, P less than 0.05). In contrast, urinary PGE2 levels did not change. A Ca++ blocker, nifedipine, alone had no effect on Bp or urinary 6-keto-PGF1 alpha levels, but completely prevented the Ca++ -induced rise in Bp and 6-keto-PGF1 alpha excretion (158 +/- 30 vs. 182 +/- 38, P greater than 0.2). However, the rise in 6-keto-PGF1 alpha was not altered by the alpha 1 antagonist prazosin (159 +/- 21-258 +/- 23, P less than 0.02), suggesting that calcium entry and not alpha 1 receptor activation mediates Ca++ pressor and PGI2 stimulatory effects. These data indicate a new vascular regulatory system in which PGI2 modulates the systemic and renal vascular actions of calcium in man.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Occult spinal dysraphism. Case report and review of the literature.

This case report and review of the literature is presented to create a greater diagnostic awareness of occult spinal dysraphism. Early recognition is based upon an understanding of this congenital anomaly and its variable presentations. These most commonly include abnormal gait, various cutaneous manifestations, particularly subcutaneous lipomata, and less frequently urological complaints. Surgical intervention, to arrest disease progression, is the primary mode of treatment, and functional improvement is variable. Long-term prognosis is dependent upon severity of neurologic deficits prior to surgery and the type of lesion found intraoperatively. Familial occurrence has been reported and genetic counseling may be an important preventive measure. Recent radiologic investigations have been concerned with the use of ultrasonography in screening infants at risk.

Child↗