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Biomedical subjects

M S Edwards

Publications and source records attributed to M S Edwards.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

Posterior fossa hemorrhage in term newborns.

Posterior fossa hemorrhage detected by computed tomography (CT) in seven term newborns was managed by nonsurgical means. All infants were developmentally normal two to four years later with the exception of one infant who died with a massive posterior fossa hemorrhage. Two infants with extensive hemorrhages developed hydrocephalus. Spinal fluid drainage and diuretic therapy resulted in the resolution of hydrocephalus in one infant and delayed the placement of a ventriculoperitoneal shunt in the other. This series documents normal outcome in nonsurgically managed neonatal posterior fossa hemorrhages of varying degrees of severity.

Birth Injuries↗
PubMedDate not supplied

Outcome of brain abscess treatment in children: reduced morbidity with neuroimaging.

Records were reviewed of 17 patients, ages 4 months to 18 years, who had been diagnosed as having brain abscesses between 1975-1984. Serial computed tomography was used to guide treatment; consequently, 8 patients were managed medically and 9 received surgical intervention. All medically treated patients were free of neurologic residua upon subsequent examination. Positive identification of organisms from systemic cultures and close computed tomographic monitoring prevented the need for surgical intervention in these patients. The surgically treated patients were sicker at presentation, and of the 9 patients requiring surgical intervention, 4 had neurologic sequelae and 1 patient died. Brain abscess aspiration or excision revealed organisms in 7 of the 9 surgically treated patients. The reduction in morbidity and mortality was due in part to early recognition and monitoring of abscess size with contrast-enhanced computed tomography and avoidance of surgical excision of the abscess.

Adolescent↗
PubMedDate not supplied

Continuous and discontinuous protein antigenic determinants.

Protein antigenic determinants have been classified as continuous or discontinuous. The continuous determinants are composed of residues which are local in the polypeptide sequence, while discontinuous determinants consist of residues from different parts of the sequence, brought together by the folding of the protein to its native structure. Searches made for protein determinants using peptide fragments which compete with protein-antibody complex formation, or peptides that can be used to raise antibodies which crossreact with the native protein, are limited to the simulation of continuous determinants. However, recent experiments suggest that most determinants are discontinuous. We now show, by consideration of protein surfaces, that if the recognition zone between a protein and antibody has the same dimensions as those found for the lysozyme-antibody complex, none of the protein's surface will be 'continuous'. We suggest that all determinants are discontinuous to some extent, and that crossreacting peptides mimic only the 'primary' interaction site. In addition, we show that the parts of a protein's surface which are most continuous fall predominantly in the loops and/or protruding regions. This explains why quantities such as hydrophilicity, accessibility, mobility and protrusion can be used to predict which parts of a polypeptide provide the 'best' antigenic peptides.

Antigen-Antibody Reactions↗
PubMedDate not supplied

Amebic liver abscess in children.

Five children with amebic liver abscesses are presented, and the distinctive clinical and laboratory features for these and 119 other children are described. The majority (91%) were less than 3 years old, and 77% had an isolated abscess in the right hepatic lobe. Each child presented with a history of fever and gastrointestinal symptoms, and two-thirds presented with cough or difficulty breathing. Most (81%) patients had hepatomegaly on physical examination and some had a well-defined mass. Hematologic abnormalities including anemia, neutrophilia and an increased ratio (greater than 0.15) of immature neutrophils to total neutrophils were commonly observed at the time of admission. Of interest, intravenous pyelograms revealed deviation of the right kidney due to hepatomegaly in each of three children studied. All patients evaluated had one or more filling defects demonstrated by liver-spleen scan or abdominal ultrasound. Most patients underwent either an open (9%) or closed (77%) drainage procedure. Fifty-six children (46%) died, in some cases before specific therapy was instituted. Of those who recovered all received therapy with metronidazole or a combination of chloroquine with emetine or dehydroemetine.

Amebicides↗
PubMedDate not supplied

Median sternotomy wound infections in children.

Nine children (25 days to 15 years of age) with infectious complications of median sternotomy are described. Six infections were superficial and in three the sternum and/or mediastinum was involved. Risk factors predisposing to sternal wound infections in six patients were a pump bypass time in excess of 1 hour, excessive postoperative bleeding, low cardiac output for 24 hours or more postoperatively, reexploration for control of bleeding and inadequate antimicrobial prophylaxis. Eight infections were diagnosed at a mean of 15 days postoperatively (range, 5 to 30 days), and chronic sternal osteomyelitis was diagnosed 4 years after operation in one patient. Stability of the sternum was a critical feature differentiating between superficial and deep wound infections. Staphylococcus aureus or Staphylococcus epidermidis was isolated from the wound and/or blood of five patients, and Gram-negative enteric rods were isolated in three patients (two with sternal osteomyelitis and mediastinitis). Local debridement was sufficient for adequate drainage in four patients, but reexploration for debridement and rewiring of the sternum or drainage of mediastinal contents was required in four. All patients improved initially following drainage and administration of parenteral antibiotics for a mean of 12 (superficial infection) or 28 (deep infection) days. Two patients developed chronic sternal osteomyelitis, and one died due to rupture of a mycotic aneurysm of the aorta 7 years postoperatively.

Adolescent↗
PubMedDate not supplied

Venereal herpes: a nursing overview.

Nursing problems associated with venereal herpes are examined. Clinical manifestations, as well as specific effects on the pregnant woman, fetus, and neonate, are discussed. Additional discussion focuses on prevention and therapy and the relation of venereal herpes to cervical cancer. A list of nursing implications is appended; it includes assessment and intervention, patient teaching, nursing education, and public policy.

Abortion, Spontaneous↗
PubMedDate not supplied

Pediatric neurosurgical implications of the amniotic band disruption complex. Case reports and review of the literature.

Defects caused by the amniotic band disruption complex (ABDC) may vary from simple malformations caused by digital constriction to major scalp, craniofacial, and visceral malformations. ABDC may cause 7-14% of stillbirths. The etiology is unclear, but the most commonly accepted mechanism involves rupture of the amnion followed by fetal malformation, deformation, and compression. This mechanism does not adequately explain all anomalies such as hydrocephalus and holoprosencephaly that are seen in the ABDC. The use of prenatal ultrasound has allowed the diagnosis of the ABDC in utero. Since 1980, four children with the ABDC who required neurosurgical intervention were seen at the University of California, San Francisco; the presentation and subsequent surgical treatment of 2 of these children are discussed. A combined craniofacial team approach to the management of these children can maximize reconstructive and neurologic outcome.

Abnormalities, Multiple↗
PubMedDate not supplied

Magnetic resonance analysis of suprasellar tumors of childhood.

A retrospective analysis of the magnetic resonance (MR) images in 53 pediatric patients with pathologically proven suprasellar tumors was performed, in an attempt to identify the characteristic MR features of these tumors and assess the capability of MR to predict a histologic differentiation. The tumors analyzed included 29 astrocytomas, 11 craniopharyngiomas, 4 germinomas, 3 pituitary adenomas with suprasellar extension, 2 teratomas, 1 spindle cell tumor, 1 primitive neuroectodermal tumor, 1 arachnoid cyst and 1 chordoma of the clivus with suprasellar extension. Thirty patients received intravenous Gd-DTPA as part of their MR exam. Certain MR features, while not pathognomonic, are quite helpful in the differentiation of craniopharyngiomas from chiasmatic/hypothalamic astrocytomas. Presence of a high signal intensity component on T1-weighted images, cyst formation with macrocystic predominance, irregular, heterogeneous solid portion, and smooth ring cyst wall enhancement represent the key characteristics of craniopharyngiomas. Solid predominance with microcysts, long T1 and T2 relaxation times, intense enhancement after contrast administration and extension along the posterior optic pathways are the typical MR findings of chiasmatic/hypothalamic astrocytomas. Presence of diabetes insipidus in correlation with the MR findings of a well-marginated, round or lobular tumor with prolonged T1 and T2 relaxation times, which enhances strongly after Gd-DTPA administration may be the clue in the diagnosis of suprasellar germinomas. Teratomas can be separated from other pediatric suprasellar neoplasms on the basis of internal heterogeneity with presence of fat, calcium and various soft tissue densities. Tumors invading the suprasellar cistern by extension are easily differentiated by identification of the primary site of origin. The above features, while not pathognomonic, are quite helpful in making a specific diagnosis.

Adenoma↗
PubMedDate not supplied

Congenital nasal masses: CT and MR imaging features in 16 cases.

The imaging studies of 16 children with pathologically proved nasal encephaloceles (eight), nasal dermal sinuses/nasal dermoids (seven), and nasal cerebral heterotopias, more commonly known as nasal gliomas (one), were retrospectively reviewed and compared with normal control subjects to define the normal anatomy and analyze deformities caused by these lesions. Nasal encephaloceles were always identified as complex masses of mixed soft tissue and CSF intensity that were contiguous with intracranial structures. The nasal glioma appeared as a mixed-intensity mass that, on the basis of the CT scan, appeared to be continuous with intracranial structures. Nasal dermal sinuses could only be identified as they coursed through the skin and subcutaneous soft tissue. They could not be identified when intraosseous. Moreover, on CT and, particularly, on MR, a number of potential diagnostic pitfalls were encountered. The most important of these was the normal fat deposition that occurs within bone during normal maturation and during aeration of the frontal sinuses and nasal bones. These fatty changes can easily be mistaken for fatty tumors if they are not recognized as normal anatomic changes. Interestingly, the classic plain film findings for congenital nasal masses were present only in the encephaloceles and nasal glioma; dermoids and dermal sinuses showed none of the classic plain film findings. In the six patients who had both CT and MR, the masses were easily identified and characterized by each imaging method. Congenital nasal masses are well characterized by both CT and MR. It is important to understand the normal changes in the anatomy of the nasofrontal region in the pediatric age group to avoid false-positive diagnoses in this region.

Child↗