Stages in the formation and metabolism in intracellular lipid droplets in atherosclerosis. An electron microscopical and biochemical study.
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Animals↗
Biomedical subjects
R A Clark
Publications and source records attributed to R A Clark.
Understanding barriers to condom usage among HIV-infected African American women.
Drawing on focus group discussions with adolescent and adult HIV-infected women between the ages of 16 and 45, this study explores the barriers to condom use among women infected with HIV. Although most of the participants were comfortable discussing condoms and sexuality, there was little, if any, negotiation of condom use with their male partners. Most of the participants used condoms inconsistently or not at all. Reasons for nonuse included a lack of trust in the reliability of condoms to protect them, a lack of desire for pregnancy prevention, and the male partner's refusal to use condoms. Women in discordant relationships explained their uninfected partner's refusal to use condoms as denial of the risk of contracting HIV or as a way of expressing their love for the infected partner. Women also had great difficulty in disclosing their HIV status to both family and partners. Prevention efforts to increase condom use among HIV-infected women should target both men and women and focus on negotiation and communication skills.
Adolescent↗
Role of computed tomographic arterial portography and intraoperative ultrasound in the evaluation of patients for resectability of hepatic lesions.
Computed tomographic arterial portography (CTAP) has been shown to be the most sensitive preoperative test for determining resectability of hepatic lesions but we have shown it to have low specificity. Intraoperative ultrasound (IOUS) evaluation of the liver has also been proposed as an accurate means of assessing resectability. We sought to compare the effectiveness of the two modalities. Fifty-six patients who had been deemed candidates for liver resection based on CTAP findings underwent systematic exploration, liver mobilization, and IOUS examination. Ultrasound findings were compared with results of CTAP. In 46 patients the IOUS findings were in complete agreement with those of CTAP. In 10 patients CTAP lesions could not be verified by IOUS and these patients did not undergo resection. Follow-up of these 10 patients revealed eight who did not have progression of malignancy at the CTAP-predicted site (CTAP false positive). Two patients did have progression at a CTAP-positive IOUS-negative site (IOUS false negative). Sensitivity for CTAP and IOUS was 100% and 96%, respectively. Specificity for IOUS was 100%. These findings demonstrate the high sensitivity of CTAP and the high sensitivity and specificity of IOUS. CTAP may "overcall" hepatic lesions but IOUS can correctly identify these false positives in most instances. Because CTAP is useful for determining which patients might benefit from surgical exploration, we conclude that the two modalities are complementary for the assessment of resectability of hepatic lesions. The false positive rate for CTAP implies that caution must be used when declining to operate on patients on the basis of this test.
Adult↗
Spectrum of Cryptococcus neoformans infection in 68 patients infected with human immunodeficiency virus.
Sixty-eight patients infected with human immunodeficiency virus (HIV) and Cryptococcus neoformans who presented to three major medical centers in New Orleans, Louisiana, were studied retrospectively. In patients with meningitis the most common presenting symptoms were fever and headache. Those without central nervous system involvement generally had an isolated pulmonary infection due to C. neoformans and presented with cough and dyspnea. CSF parameters were abnormal in 41% of patients, and the India ink preparation was positive in 88% of patients with cultures of CSF positive for C. neoformans. The overall median survival time for the 47 patients who died was 5 months, with a range of 0-22 months. Of the 27 patients who received maintenance therapy with amphotericin B, two (7%) relapsed. The only factors found to be associated with a poor prognosis were abnormal computed tomography of the head and altered mental status on presentation. C. neoformans infections in HIV-infected patients remain difficult to treat and have a poor prognosis.
Acquired Immunodeficiency Syndrome↗
Hematogenous dissemination of Mycobacterium tuberculosis in patients with AIDS.
Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.
Acquired Immunodeficiency Syndrome↗
Digital subtraction angiography of the renal arteries. Prospective comparison with conventional arteriography.
Intravenous digital subtraction angiography (IV-DSA) of the aorta and renal arteries was compared with conventional arteriography of 40 patients with 92 renal arteries. Inadequate visualization of the vessel occurred in six renal arteries (6.5%). In arteries adequately imaged, for the evaluation of renal artery stenosis, the sensitivity of IV-DSA was 87.5% (28/32), the specificity 100% (54/54), and the accuracy 95.3% (82/86). Overall, accurate IV-DSA was obtained in 89.1% (82/92) of renal arteries and 85% (34/40) of the patients. IV-DSA is an accurate screening procedure for renal artery stenosis.
Angiography↗
Computed tomography of bowel infarction.
Bowel infarction is a potentially lethal disorder that is notoriously difficult to diagnose clinically and radiographically. Computed tomography is often used in the early radiographic evaluation of patients with severe abdominal pain of unknown etiology. This study defines the CT findings in patients with bowel infarction. The findings in 22 patients with mesenteric infarction were reviewed. Seven were due to mesenteric arterial occlusion, six due to mesenteric venous occlusion, and nine were nonocclusive. The CT abnormalities were diffuse or focal bowel wall thickening (19 patients), bowel dilatation without mural thickening (three patients), intramural low attenuation zones of edema (eight patients), intramural gas (11 patients), mesenteric gas (five patients), portal or mesenteric venous gas (one patient), mesenteric vascular occlusion (eight patients), and peritoneal gas or fluid (12 patients). The diagnosis of bowel infarction must be considered when performing CT in patients with abdominal pain of unknown etiology.
Adult↗
MR imaging of chronic osteomyelitis.
Magnetic resonance (MR) at 1.5 T was used preoperatively and prior to aspiration to determine extent and location of infection in eight patients with chronic osteomyelitis. There was excellent correlation between MR and surgical findings in all cases. Infected areas, both intraosseous and extraosseous, displayed increased signal intensity on T2-weighted images. Sequestra, sinus tracts, and soft tissue abscesses were seen. By directly imaging foci of infection MR may have certain advantages over CT and scintigraphy in the evaluation of chronic osteomyelitis.
Chronic Disease↗
Sirenomelia without Potter syndrome: MR characteristics.
Sirenomelia is a rare birth defect characterized by fusion of the lower extremities into one limb and a wide spectrum of both genitourinary and lower gastrointestinal tract anomalies. We wish to report the occurrence of this syndrome in an infant whose genitourinary and gastrointestinal anomalies are compatible with life.
Abnormalities, Multiple↗
Infections during the postpartum period.
Postpartum infections are costly in terms of delayed mother-infant interaction; lactation difficulties; prolonged hospital stay or readmittance to the hospital and increased expense; and possible permanent injury or death. The nurse is in a unique position to identify the woman at risk, recognize early warning signs, and provide teaching and counseling for prevention and care. Shortened hospital stays challenge the nurse to develop, research, and discover funding for new interventions to provide care and teaching to minimize the effects of this problem.
Diagnosis, Differential↗
Thematic review series. VIII: Phagocyte antimicrobial systems. Introduction.
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Cell Degranulation↗
Cardiac arrhythmia after mushroom ingestion.
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Adult↗
Effects of shared referential experience upon encoder-decoder agreement.
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Humans↗
Magnetic resonance imaging of the breast.
BACKGROUND: Magnetic resonance imaging (MRI) has the potential to become a useful adjunct in breast imaging. Contrast-enhanced breast MRI has demonstrated a high sensitivity in the detection of invasive breast cancer. In clinical studies, breast MRI has often altered the course of patient care. Although promising results have been generated, MRI of the breast is currently in a development stage. METHODS: The authors reviewed the literature on the potential indications, sensitivity, specificity, and limitations of MRI of the breast. RESULTS: Reported advantages of MRI of the breast over conventional imaging techniques include improved staging and treatment planning, enhanced evaluation of the augmented breast, better detection of recurrence, and improved screening of high-risk women. Contrast-enhanced breast MRI is a sensitive modality for detecting breast cancer, but its variable specificity is a major limitation. CONCLUSIONS: MRI of the breast is emerging as a valuable adjunct to mammography and sonography for specific clinical indications. Additional clinical studies that define indications, interpretation criteria, imaging parameters, and cost effectiveness are needed. A multi-institutional study designed to address these issues is in progress.
Breast↗
Role of fine needle aspiration cytology after lumpectomy.
Lumpectomy with axillary dissection followed by radiotherapy is a frequently utilized technique for the treatment of selected breast carcinomas. Following this procedure, patients often present within a variable period of time with either clinical or mammographic abnormalities at the lumpectomy site suggesting recurrent cancer. In order to evaluate the utility of fine needle aspiration biopsy (FNAB) in the follow-up of such patients, aspirates were obtained 1-73 months after lumpectomy from 72 patients. A spectrum of cytologic changes was seen as a consequence of surgery and irradiation at the site of the lumpectomy as well as in the axilla and lumpectomy scar. The majority of these changes (94%) were benign and generally resolved during follow-up visits. Recurrent malignancy was detected in 4 of 72 patients. These results show that FNAB can reliably differentiate benign from neoplastic changes in postlumpectomy patients and indicate that FNAB may play an important role in the nonsurgical management of clinically alarming but benign postlumpectomy lesions.
Biopsy, Needle↗
Mass mammography screening: using an information system to track participation and identify target populations.
This article describes the 1991 American Cancer Society Greater Tampa Bay Breast Screening Program and an information system developed to track participants from the point of inquiry to mammography results. Information from three sources was linked to create a comprehensive data base, including participant demographics, mammography history, perceived risks of breast cancer, barriers to mammography, and mammography results. This comprehensive data base allowed investigators to describe the 11,134 participants and to assess the program's impact. The analysis suggested that women older than 65 years are underrepresented in this voluntary program. Black women were less likely to participate, as were women in lower income and education groups. To reduce mortality effectively, leaders of mass screening programs need to develop creative strategies for reaching these high-risk groups. Effective information systems can identify program weaknesses and track the impact of changes.
Adult↗
Imprint cytology of needle-localized breast lesions.
Intraoperative evaluation of nonpalpable breast lesions by frozen section frequently is not performed because of potential tissue loss, sampling errors and frozen section artifacts. In a retrospective review we found that only 50 of 503 needle-localized breast biopsies (NLBBs) were evaluated at our institution by frozen section (FS), with a sensitivity of 88%. However, intraoperative evaluation of such lesions may be essential to single-stage and cost-effective management. To this end, this study evaluated the diagnostic accuracy and potential clinical role of intraoperative imprint cytology (IIC) in NLBB. A total of 88 lesions were evaluated by IIC and permanent histology. Fifteen of them were also concomitantly evaluated by FS. All but one deferred cytologic diagnoses were correct. Twelve of 15 FS diagnoses were correct, 2 were deferred, and 1 was false negative. The data suggest that IIC may circumvent some of the difficulties associated with FS, thereby allowing immediate clinical management and later definitive histologic typing and evaluation of prognostic parameters in nonpalpable breast lesions.
Adenoma↗