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Biomedical subjects

R Gray

Publications and source records attributed to R Gray.

At least 289 records · Page 16Linked to original sources
PubMed1988

Duodenal perforation by a Linton-Nachlas balloon tube.

In a patient with bleeding esophageal varices, inadvertent inflation of a Linton-Nachlas balloon in the third portion of the duodenum led to bowel perforation and death. This complication emphasizes a potential problem in passing a balloon catheter as far as possible down the nares, a technique that has been suggested to prevent balloon catheter inflation in the esophagus. To the best of our knowledge, this is the first reported case of duodenal rupture from attempted balloon tamponade for variceal hemorrhage.

Balloon Occlusion↗
PubMed1988

Recent developments in aortic stenosis.

There have been several recent advances in our understanding of aortic stenosis and in its diagnosis and treatment. Aortic stenosis is now most commonly due to a bicuspid valve. Rheumatic aortic stenosis has become much less common and calcific stenosis of valves in the elderly is a rapidly increasing cause. The prognosis of patients with aortic stenosis can be largely determined by their symptoms, with a mean length of survival of 3 to 5 years for patients with angina, 3 years for patients with syncope, and only 12 to 24 months for patients with heart failure. Virtually all symptomatic patients should be operated on, even those with reduced left ventricular function. The risk of sudden death in asymptomatic adults is low, and thus surgery is generally not needed in these cases. Recently, the noninvasive diagnosis of aortic stenosis has improved dramatically with the advent of two-dimensional and Doppler echocardiography. These techniques provide information on the pressure gradient and can even allow accurate estimates of valve area. Cardiac catheterization is still required, however, to determine the anatomy of the coronary arteries prior to surgery since many patients will have concomitant coronary artery disease. The newest development in the treatment of aortic stenosis is catheter balloon valvuloplasty, which is relatively safe and has shown early promise in reducing the pressure gradient across not increased to the normal range and is significantly less than that following aortic valve replacement. The long-term results of balloon valvuloplasty are still being evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Stenosis↗
PubMed1987

The numerical approach to classification: a medical application to develop a typology for facial pain.

Applications of numerical taxonomy in medicine are relatively rare. We describe an application in which a new typology is developed for the classification of pain distribution in patients with temporomandibular pain dysfunction syndrome. The methodology of the numerical approach is presented and key issues are highlighted, especially relating to validation of taxonomic structure. From the dendrogram obtained by Ward's hierarchical method, five pain groups are distinguished which relate systematically to anatomy and are clinically meaningful. Cluster structure is subjected to a battery of reproducibility tests and is found to be broadly reproducible for different algorithms and sub-samples of subjects. Finally, the new typology is shown to have heuristic value in providing fresh insight into the nature of a complex syndrome.

Algorithms↗
PubMed1987

Computed tomography of superior vena cava obstruction.

Which imaging procedure is best for the diagnosis of the superior vena cava (SVC) syndrome is subject to considerable debate. Available imaging procedures include the plain chest film, SVC phlebography, scintiangiography, digital phlebography, CT digital phlebography, and CT. In our experience the combined technique of contrast enhanced CT axial images, followed by a CT digital phlebogram, is the most informative, cost-effective, and least invasive method available.

Humans↗
PubMed1987

Catamenial pneumothorax: case report and literature review.

Since the initial case report in 1958, 69 cases of catamenial pneumothorax have appeared in English-language literature. Despite the extensive case material, the pathogenesis has not been fully elucidated. Herein an additional case is reported utilizing computed tomography (CT) to search for intrathoracic endometrial implants. The four major pathogenetic theories include passage of air from the genital tract via diaphragmatic defects, spontaneous rupture of subpleural blebs, intrathoracic endometriosis, and prostaglandin-induced bronchiolar constriction resulting in alveolar rupture. Evidence for and against each theory is presented.

Adult↗
PubMed1987

Comparison of 1 + 5 DAT and 3 + 10 DAT followed by COAP or MAZE consolidation therapy in the treatment of acute myeloid leukemia: MRC ninth AML trial.

This trial, which will probably accrue over 1,000 patients before it closes, has already demonstrated that high remission rates are attainable in large multicenter studies using 'conventional' doses of ara-C. The results in the group aged less than 40 are comparable with many single-center studies. There is, at the moment, only a borderline difference in the remission rates between the two forms of induction therapy but the more intensive regimen of DAT 3 + 10 achieves remission more quickly and requires less supportive care. Analysis of the reasons for failure to enter remission continues to show that inadequate supportive care remains an important reason why the remission rates are not higher. Drug-related deaths in remission, though decreasing gradually in this study, are a disturbing consequence of increasing the intensity of consolidation treatment.

Adolescent↗
PubMed1987

Predicting the clinical course in intentional drug overdose. Implications for use of the intensive care unit.

Many patients admitted for observation to the intensive care unit after a drug overdose do not ultimately require intensive care interventions. We retrospectively analyzed data on 209 overdose cases to determine whether clinical assessment in the emergency room could identify patients at risk for complications. Patients were classified as low risk when none of the following high-risk criteria were present in the emergency room: need for intubation; seizures; unresponsiveness to verbal stimuli; arterial carbon dioxide pressure (tension) greater than or equal to 45 mm Hg; any rhythm except sinus; second- or third-degree atrioventricular block; QRS greater than or equal to 0.12 s; or systolic pressure less than 80 mm Hg. Of 151 low-risk patients, none developed a high-risk condition after admission, and none required an intensive care intervention. The use of these predictive criteria in our patient population would have eliminated over half the intensive care days without compromising quality of care.

Adult↗
PubMed1986

Chemotherapy for advanced pancreatic cancer. A comparison of 5-fluorouracil, adriamycin, and mitomycin (FAM) with 5-fluorouracil, streptozotocin, and mitomycin (FSM).

One hundred ninety-six patients with advanced pancreatic cancer were randomized to receive one of two combination chemotherapy programs: FAM (5-fluorouracil, Adriamycin [doxorubicin], mitomycin) or FSM (5-fluorouracil, streptozotocin, mitomycin). Patient characteristics were comparable in both groups. Overall response rates for those with measurable disease (14% on FAM, 4% on FSM) were not significantly different (P = 0.07). There was no significant difference in overall survival between patients treated with FAM and FSM (median survivals of 26 and 18 weeks, respectively). Survival benefits of FAM were significant only for patients with measurable disease. Toxicity of both regimens was acceptable and comparable, aside from greater renal toxicity and more nausea and vomiting with FSM. The results failed to confirm the 35% to 40% response rates previously reported for FAM and FSM in advanced pancreatic cancer.

Adenocarcinoma↗
PubMed1986

Aortic pseudo-aneurysm with Aspergillus aortitis. An unusual complication of coronary bypass surgery.

This is the first report of fatal postoperative Aspergillus infection in an aortic pseudoaneurysm associated with a jet lesion produced by a deformed, but hemodynamically normal aortic valve. Widespread arterial embolization was the principal feature and resulted in death on the 12th hospital day due to massive thromboembolism to the brain three months after successful coronary bypass surgery. Possible sources of such infections and the potential effect of the jet lesion are discussed.

Aged↗
PubMed1986

Tamoxifen versus placebo: double-blind adjuvant trial in elderly women with stage II breast cancer.

One hundred eighty-one elderly women with stage II breast cancer were prospectively randomized to receive tamoxifen or placebo for 24 months in a double-blind adjuvant trial conducted by the Eastern Cooperative Oncology Group. They were stratified prior to randomization on the basis of the number of positive axillary nodes and the estrogen receptor status of their primary tumor. One hundred seventy were considered eligible and analyzed in this trial. The median age was 71 years with a range from 65 to 84 years. Twenty-one percent of the patients were over the age of 75 and 33% were between 71 and 75 years. Estrogen receptor status was positive in 85% of the patients and unknown in another 12%. Progesterone receptor status was positive in 35%, negative in 16%, and unknown in 49%. With a median follow-up of 55 months, the overall percent disease free at 4 years is 73 for the tamoxifen arm and 52 for the placebo arm (P = .003). Significant benefit is seen following tamoxifen in the subsets with 4-10 positive axillary lymph nodes, those who were estrogen receptor positive, or progesterone receptor unknown, and those who had a tumor size less than 3 cm. Most other subsets benefited as well. There were more distant (29 vs. 13) and bone only (15 vs. 3) sites of first recurrence in the placebo arm, whereas locoregional recurrences were similar (8 each). The recorded toxicity was similar, except for more hot flashes observed among women in the tamoxifen arm.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Postoperative chemotherapy and chemohormonal therapy in women with node-positive breast cancer.

Separate trials for premenopausal and postmenopausal (less than or equal to 65 yr of age) patients with node-positive breast carcinoma were initiated by the Eastern Cooperative Oncology Group in 1978 to evaluate adjuvant chemotherapy and chemohormonal therapy approaches. Postoperative patients were stratified by degree of axillary nodal involvement and estrogen receptor (ER) status prior to randomization. Premenopausal patients received 12 monthly cycles of intermittent cyclophosphamide, methotrexate, and 5-fluorouracil (CMF), CMF plus prednisone (CMFP), or CMFP plus continuous tamoxifen (CMFPT). Postmenopausal patients received either observation or 12 monthly cycles of CMFPT or CMFP. The median follow-up for the analyzed patients is 54 months for the 553 premenopausal patients and 59 months for the 223 postmenopausal patients. The premenopausal trial has not demonstrated any significant differences between the regimens for either relapse-free or overall survival. The relapse-free survival in the postmenopausal trial has demonstrated a trend for CMFPT over observation (P = .07). Both CMFP and CMFPT are associated with an improved relapse-free survival over observation alone in ER-negative patients (P = .01) and in progesterone receptor-negative patients (P = .01). However, the relapse-free survival advantages have not translated to survival. Side effects were significantly increased with the addition of P to CMF in the premenopausal trial. The addition of T to CMFP was associated with an increased incidence of edema and hot flashes in premenopausal patients; however, the latter was decreased in postmenopausal patients relative to CMFP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗