NMTCB 1997. Task analysis report. Nuclear Medicine Technology Certification Board.
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Allied Health Personnel↗
Biomedical subjects
P Wells
Publications and source records attributed to P Wells.
Cervical angina.
Cervical angina is defined as chest pain that resembles true cardiac angina but originates from a cervical discopathy with nerve root compression. This condition, which is also referred to as pseudoangina, most commonly results from compression of the C7 nerve root. Several simple findings from the history and the physical examination help make the diagnosis, which can then be confirmed with magnetic resonance imaging and/or discography. Coexisting coronary artery disease must always be ruled out. Treatment includes intermittent cervical traction, physical therapy, nonsteroidal anti-inflammatory drugs and muscle relaxants. If these measures fall to alleviate the patient's pain, referral to a spine surgeon may be indicated.
Cervical Vertebrae↗
New concepts in coagulation.
The process of blood coagulation is a complex and incompletely understood process. In the last decade or so critical steps have been taken toward better understanding this process. It is now widely agreed that the principal initiating pathway of coagulation is the so-called extrinsic pathway due to the action of tissue factor and Factor VII. Concomitant with this appreciation has come an understanding and elucidation of the roles of tissue factor pathway inhibitor. Although the "intrinsic pathway" is no longer felt to be the initiator of coagulation, recent evidence suggests that Factor XIa may constitute an important amplification pathway of the coagulation system in vivo. Refinement of flow cytometry has enabled the detection of novel platelet antigens on activated platelet surfaces. It is hoped that detection and characterization of these antigens, including adhesion molecules such as P-selectin, will enable further understanding of the platelet's role in pathological coagulation and inflammation. The endothelium is also intricately involved and recent work has determined the importance of endothelial produced factors such as endothelium-derived relaxation factor, endothelin, and thrombomodulin. Finally, with the meteoric rise in molecular genetic technology, specific genetic abnormalities in a number of plasma proteins has been elucidated, with marked implications on the understanding of the coagulation process. For example, the mutation on the gene for Factor V, leading to Arg506 replacement with Gln, produces activated protein C resistance with a concomitant increased risk of venous thrombosis. Thus, significant advances in knowledge of the endothelium, platelets, and plasma factors involved in coagulation have been made and now the challenge of the future is to better elucidate the interactions of these components.
Anticoagulants↗
Tranexamic acid use during coronary artery bypass grafting.
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Antifibrinolytic Agents↗
Positron emission tomography: a new investigational area for cancer research.
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Antineoplastic Agents↗
The effect of radiotherapy on urethral obstruction from carcinoma of the prostate.
OBJECTIVE: To assess the impact of radiotherapy on the relief of complete bladder outlet obstruction requiring catheterization secondary to prostatic carcinoma. PATIENTS AND METHODS: From a consecutive series of 151 patients treated with radiotherapy for localized carcinoma of the prostate, 19 (12.6%; median age 72 years, range 59-83) who had an indwelling catheter in situ at the time of irradiation because of urinary retention, were analysed retrospectively and grouped according to the stage and grade of tumour and the irradiation dose delivered. RESULTS: The catheter was removed following radiotherapy in all but two patients, who both had stage 4 tumours, and normal urinary function was restored. The grade and stage of tumour did not influence the duration of catheterization. The median time from completion of radiotherapy to catheter removal was 10 weeks (range 0-46). Recatheterization was required in two patients at 3 and 64 months after radiotherapy and three patients, including these two, required transurethral prostatectomy (TURP) to relieve outlet obstruction. CONCLUSION: Prostatic radiotherapy is effective in relieving bladder neck obstruction caused by prostate cancer. Most patients will achieve normal urinary function without requiring TURP after treatment.
Aged↗
The respiratory development of Atlantic salmon. I. Morphometry of gills, yolk sac and body surface
During development from larva to juvenile in Atlantic salmon, Salmo salar, there is a change in the anatomical potential for gas exchange among gills, body skin and yolk sac as the larvae resorb yolk, grow and develop gills. Newly hatched Atlantic salmon have poorly developed gills but do have a high skin area to mass ratio and a large well-vascularized yolk sac. Cutaneous surfaces accounted for over 95 % of the total area available for respiration in newly hatched Atlantic salmon (body mass 0.032­0.060 g). The branchial contribution to total area increased rapidly, however, so that by the end of yolk absorption (body mass 0.19­0.23 g) it constituted 22 % of the total area and overtook cutaneous surface area between 5 and 6 g wet body mass. Harmonic mean diffusion distance across the skin increased through development from 20 µm at hatch (14 µm across the yolk sac) to 70 µm in an 11 g fish. Diffusion distances across both the filaments and lamellae of the gills decreased through development, from 3.7 to 2.4 µm for lamellae and from 14.5 to 10.8 µm for filaments. The total anatomical diffusion factor (ADF, mass-specific surface area per unit diffusion distance) remained constant over early development and appeared to be higher than in adult fish. The distribution of ADF changed over early development from 50 % yolk sac, 42 % body surface and 8 % branchial in newly hatched fish to 68 % branchial and 32 % cutaneous at the end of yolk resorption. Generally, early post-hatch development of gills, ADF and some cutaneous surfaces showed high mass exponents. After yolk resorption (body mass 0.2 g), however, these coefficients were lower and closer to unity. The change in scaling at the end of yolk resorption in this study may reflect the completion of larva to juvenile metamorphosis in Atlantic salmon. Comparison between our data and values in the literature suggests that the timing of gill development is related more to developmental stage than to body size.
Journal Article↗
The respiratory development of Atlantic salmon. II. Partitioning of oxygen uptake among gills, yolk sac and body surfaces
During post-hatch development of Atlantic salmon (Salmo salar L.), O2 uptake partitioning changes from primarily cutaneous to primarily branchial. Over 80 % of post-hatch O2 uptake was cutaneous, with the yolk sac responsible for 33 % of total O2 uptake. The well-vascularized yolk sac was a less effective gas exchanger than the unperfused skin of the body, suggesting that oxygen delivery is by direct diffusion to the tissues. Branchial O2 uptake increased quickly as gill lamellae developed, contributing 60 % of total O2 uptake before the completion of yolk resorption (body mass 0.2 g) and increasing to 69­81 % in fish weighing over 0.3 g. The area-specific O2 uptake of the skin decreased through development as skin thickness increased, while that of the gills increased from 0.10 µg h-1 mm-2 to 0.23 µg h-1 mm-2. Partitioning of O2 uptake of the skin and gills changed in concert with changes in the partitioning of the anatomical diffusion factor (ADF, mass-specific surface area per unit diffusion distance) between skin and gills, which changed from more than 95 % to less than 10 % cutaneous; thus, ADF is a useful rough indicator of oxygen uptake potential. Caution should be used in predicting oxygen uptake potential from ADF, however, because O2 uptake per unit diffusion barrier of the yolk sac was less than half that of the general body surface, and O2 uptake per unit diffusion barrier of the gills changed dramatically over development.
Journal Article↗
Thromboembolism after major trauma.
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Humans↗
Cutaneous B-cell lymphoma with subsequent laryngeal involvement.
Cutaneous lymphoma is uncommon and lymphomatous infiltration of the larynx, occurring either as primary disease or as a feature of multifocal disease, is rare. We report a case of cutaneous, high grade non-Hodgkin's lymphoma with isolated relapse in the larynx. The laryngeal deposit was identical to the original cutaneous lymphoma, demonstrated histologically and using the polymerase chain reaction. Complete remission of the primary lesion was attained with local radiotherapy, and a second complete remission with chemotherapy. To date, no case of primary cutaneous lymphoma with subsequent involvement of the larynx has been reported, but the association is worth documenting, since symptoms referable to the larynx are easily overlooked. They may indicate incipient embarrassment of the airway, thus requiring urgent investigation and treatment, which is generally highly effective.
Aged↗
Diagnostic tests for deep vein thrombosis. Clinical usefulness depends on probability of disease.
We review the general principles that govern the clinical utility of diagnostic tests, particularly with respect to the diagnosis of deep vein thrombosis (DVT). We stress the importance of clinical probability of disease, which strongly influences the positive predictive value (true-positive rate) and negative predictive value (true-negative rate) of all diagnostic tests. In selecting a diagnostic procedure for DVT, the physician must first consider the clinical probability of disease and then the local accuracy of the test employed and its cost-effectiveness. In 75% to 80% of patients suspected to have DVT, clinical management can be based on the results of noninvasive tests, such as ultrasonography or impedance plethysmography (IPG), rather than venography. Ultrasonography has clear advantages over venography with respect to cost and patient comfort, and it defines the anatomic extent of the thrombus. It should be considered the new diagnostic standard for symptomatic DVT. Despite recent reports of lower sensitivity than previously reported, IPG remains an acceptable alternative to ultrasonography for symptomatic DVT in selected patients. Even if the recently reported lower sensitivity proves to be accurate, the probability of adverse clinical outcomes as a result of overlooked disease is still extremely low in patients with a low probability of DVT. The negative predictive value of IPG under these circumstances approaches 99%. Impedance plethysmography is also useful in patients with a high probability of DVT, in whom the positive predictive value may be as high as 97%. When the findings of IPG (or ultrasonography) are at variance with a strong clinical impression, venography should be considered, especially when there is a high clinical probability of disease and a negative noninvasive test result.
Bias↗
A simpler approach to hysterectomy: one-suture laparoscopic hysterectomy.
This article describes in detail a new approach to laparoscopic hysterectomy. It is based on understanding the vasculature of the uterus, cervix, and cardinal ligament. The result of this appreciation of the anatomy is a clean, logical, rapid, anatomic approach to hysterectomy not previously promoted. There is a dissectible, loose, fibrous plane that lies between the uterus and the portion of the uterine artery that courses up and down the side of the uterus. It is traversed by multiple small branches of the uterine artery, which are coagulated easily with monopolar coagulation current. By the dissection of this plane down the side of the uterus and cervix, the cardinal ligament can be peeled off the cervix. This allows a bloodless dissection well away from any risk of injury to the ureter. The anatomy and surgical technique are described for laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy.
Female↗
Autologous bone marrow transplantation in multiple myeloma: a single centre experience of 23 patients.
We report the complications and outcome of high-dose melphalan and TBI combined with ABMT used in the treatment of multiple myeloma at a single centre. Twenty-three patients, aged 65 years or less, who underwent the procedure are reviewed. All had chemosensitive disease. Response to ABMT assessed at 3 months showed 75% of evaluable patients to have further tumour cytoreduction of at least 50%, with 24% of patients who entered ABMT with residual disease eventually achieving CR. There was one toxic death. The overall survival is 60% and the progression-free survival is 49.8% at a median follow-up time of 17 months. Relapse or disease progression has occurred in 27% of patients, of whom half have died. No significant prognostic factors affecting survival were found although those patients with IgG myeloma had a better outcome. Patients transplanted in first plateau appeared to do significantly better if they had been resistant to their first-line chemotherapy but had then responded to further conventional chemotherapy (p = 0.029).
Adult↗
Ex-vivo and in-vitro evidence that low molecular weight heparins exhibit less binding to plasma proteins than unfractionated heparin.
We have compared the non-specific binding of unfractionated heparin (UFH) with that of low molecular weight heparin (LMWH) to plasma proteins both ex-vivo and in-vitro. Non-specific binding to plasma proteins was assessed by comparing the heparin levels measured as anti-factor Xa activity before and after the addition of low affinity heparin, which is essentially devoid of anti-factor Xa activity, in order to displace heparin bound to plasma proteins. For the ex-vivo studies, we compared the recovery of UFH and a LMWH (ardeparin) from the plasma of patients participating in a randomized trial of post-operative venous thrombosis prophylaxis. For the in-vitro studies, we compared the recovery of UFH and 4 different LMWHs when added to the plasma from healthy volunteers and from patients with suspected venous thromboembolic disease. The results indicate that the recovery of LMWH is much less affected by nonspecific binding to plasma proteins both ex-vivo and in-vitro. In addition, there are differences between the LMWHs with respect to their plasma protein-binding.
Blood Proteins↗
In-patient treatment of 165 adolescents with emotional and conduct disorders. A study of outcome.
A two-year follow-up study of 165 teenagers with conduct and emotional disorders treated as in-patients on a regional adolescent unit (YPU) is described. The target types of behaviour for each subject were scored independently by the teenager, the parent or guardian, and the professional referrer before admission and at one month, one year and two years after discharge. The significant overall improvement in behaviour observed at one month after discharge was sustained at one and two years. Thirty-three subjects who abandoned treatment within six weeks of admission had made significantly less progress than the fully treated group at one month after discharge, but there were no significant differences at the one- and two-year evaluations. Two years after treatment, between 69% and 79% of the 132 subjects who completed treatment were regarded as improved, depending on which respondent made the assessment. Adolescents who completed treatment had different characteristics from those who terminated treatment prematurely and were more likely to be girls in care referred by social services.
Adolescent↗
Referral rates to a regional adolescent psychiatric service: a comparison of visited and unvisited general practitioners.
A survey was undertaken through personal visits to general practitioners to determine the effectiveness of distributing information about a Regional Adolescent Psychiatric Service for emotionally and conduct disordered adolescents. The referral rates to the Unit over the four years before, and over the four years after the period of the visits were recorded both for those GPs who were visited and those who were not. The findings show an immediate significant increase in referral rates among the visited general practitioners, which was still evident after four years. This finding supports the hypothesis that a personal approach is more likely to be an effective means of disseminating information than posted printed materials. This paper also contains a description of other valuable, but unquantifiable results.
Adolescent↗
Parathyroid imaging with technetium-99m-sestamibi: preoperative localization and tissue uptake studies.
The accepted radionuclide method for imaging abnormal parathyroid tissue has been the combined use of [99mTc]pertechnetate 201Tl-chloride. Various problems with this approach, however, have suggested the need for an improved parathyroid imaging agent. This study examined the use of 99mTc-sestamibi as a parathyroid imaging agent compared with 201Tl-chloride. Fifty-seven patients were scanned with both 99mTc-sestamibi and 201Tl preoperatively. There were 40 adenomas, of which 37 were localized with 201Tl and 39 with sestamibi. Fifteen patients had hyperplastic glands, of which 29 glands were localized with 201Tl and 32 with sestamibi. Possible differences in uptake of the two agents by thyroid and parathyroid tissue were examined by administering 10 MBq of each agent to patients undergoing surgical exploration and biopsy. Preoperatively 20 patients were studied (13 adenomas and 7 with hyperplasia). Thallium-201 uptake was higher in both the parathyroid and thyroid tissue than sestamibi. However, the uptake per gram of parathyroid tissue of sestamibi was higher than the uptake per gram of thyroid tissue. This was not true for 201Tl. Technetium-99m-sestamibi was at least as effective as 201Tl in parathyroid localization. This may be partly due to a higher target-to-background ratio, but also to the superior physical characteristics of 99mTc.
Adenoma↗
Diastolic potentials recorded by surface electrocardiographic signal averaging during sustained ventricular tachycardia: possible origin from the reentrant circuit.
ECG signal averaging can detect low amplitude diastolic potentials in sinus rhythm. We, therefore, recorded signal-averaged ECGs during eight episodes of inducible uniform sustained VT with coincident atrial pacing to look for continuous diastolic electrical activity. Simultaneous AV pacing in seven patients served as controls. The number of QRS complexes averaged (187 +/- 47 vs 183 +/- 63), the noise level (1.26 +/- 0.88 vs 1.39 +/- 0.47) and cycle length (385 +/- 52 vs 404 +/- 40) did not differ between VT and paced recordings. In each lead the difference in onset between the unfiltered surface recording and the filtered data (40 Hz bidirectional) was significantly greater in VT than the paced recordings (25 +/- 16 vs 11 +/- 8 msec, P = 0.0012). These late diastolic (pre-QRS) potentials were greater than 15 msec duration in 65% of the leads in VT versus 20% of paced recording (P = 0.021). The maximum value was greater than 20 msec in six VT (75%) versus one (14%) paced recording (P = 0.019). The earliest filtered onset in any lead preceeded the earliest surface activity by greater than 12 msec, in 6 VT versus one paced recording (P = 0.019). Early diastolic (post-QRS) potentials were also longer in VT than pacing (49 +/- 40 versus 5 +/- 20, P = 0.001) and exceeded 38 msec in seven of the VTs but none of the paced recordings (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Atrioventricular Node↗