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Biomedical subjects

R L Anderson

Publications and source records attributed to R L Anderson.

At least 109 records · Page 6Linked to original sources
PubMed1994

Concordance between patients and informants on the personality disorder examination.

OBJECTIVE: Difficulties in the assessment of personality disorders and the burgeoning interest in axis II have led to increased use of informants when studying these conditions. The present study sought to evaluate the correspondence between patients and their informants on symptoms of personality disorders. METHOD: A total of 105 outpatients and knowledgeable informants were independently interviewed by using the Personality Disorder Examination, a widely used instrument for the full range of personality disorders. RESULTS: Diagnostic concordance between interviews was low (median kappa = -0.01), while correlations between dimensional scores were somewhat higher (median kappa = 0.36). Overall, patient interviews showed more pathology than interviews with informants. However, many of the symptoms obtained from informants were not reported by patients. CONCLUSIONS: These data suggest that patient-informant concordance for axis II disorders is poor for diagnoses but somewhat better for dimensional scores. There was no evidence that low agreement can be explained by patients attempting to present themselves in a favorable light. Further work is necessary to elucidate the reasons for discordance and determine which data source provides the most valid information.

Adult↗
PubMed1994

Surrogate tissues for detecting brain microemboli after cardiopulmonary bypass.

During cardiopulmonary bypass (CPB) microemboli lodge in the brain and other organs. Microemboli were counted in tissue samples of skin, muscle and brain from autopsy cases that had recently undergone CPB, and in skin and muscle biopsies obtained from patients before and after CPB. Unlike the brain, skin and muscle showed few microemboli.

Biopsy↗
PubMed1994

A comparison between the minimal model and the glucose clamp in the assessment of insulin sensitivity across the spectrum of glucose tolerance. Insulin Resistance Atherosclerosis Study.

An insulin-modified frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis was compared with the glucose clamp in 11 subjects with normal glucose tolerance (NGT), 20 with impaired glucose tolerance (IGT), and 24 with non-insulin-dependent diabetes mellitus (NIDDM). The insulin sensitivity index (SI) was calculated from FSIGTT using 22- and 12-sample protocols (SI(22) and SI(12), respectively). Insulin sensitivity from the clamp was expressed as SI(clamp) and SIP(clamp). Minimal model parameters were similar when calculated with SI(22) and SI(12). SI could not be distinguished from 0 in approximately 50% of diabetic patients with either protocol. SI(22) correlated significantly with SI(clamp) in the whole group (r = 0.62), and in the NGT (r = 0.53), IGT (r = 0.48), and NIDDM (r = 0.41) groups (P < 0.05 for each). SI(12) correlated significantly with SI(clamp) in the whole group (r = 0.55, P < 0.001) and in the NGT (r = 0.53, P = 0.046) and IGT (r = 0.58, P = 0.008) but not NIDDM (r = 0.30, P = 0.085) groups. When SI(22), SI(clamp), and SIP(clamp) were expressed in the same units, SI(22) was 66 +/- 5% (mean +/- SE) and 50 +/- 8% lower than SI(clamp) and SIP(clamp), respectively. Thus, minimal model analysis of the insulin-modified FSIGTT provides estimates of insulin sensitivity that correlate significantly with those from the glucose clamp. The correlation was weaker, however, in NIDDM. The insulin-modified FSIGTT can be used as a simple test for assessment of insulin sensitivity in population studies involving nondiabetic subjects. Additional studies are needed before using this test routinely in patients with NIDDM.

Analysis of Variance↗
PubMed1994

Embryonal rhabdomyosarcoma of the orbit in a 35-year-old man.

A 35-year-old man had rapidly progressive proptosis of the right eye with associated chemosis over a period of several weeks. Computed tomography demonstrated a solid extraconal mass in the inferior anterior right orbit. Pathologic examination revealed the lesion to be an embryonal rhabdomyosarcoma. Consistent with the diagnosis, immunohistochemical assays demonstrated positive staining with myoglobin, desmin, and muscle-specific actin. The lesion grew rapidly and was further surgically excised. Subsequently, treatment with radiation and chemotherapy was initiated. Primary embryonal rhabdomyosarcoma of the orbit is an extremely rare tumor in adults, and, to our knowledge, this patient represents the oldest individual reported to have developed such a tumor, as documented by immunohistochemical analysis.

Adult↗
PubMed1994

Orbital emphysema. Staging and acute management.

BACKGROUND: Orbital emphysema is usually a benign, transient phenomenon. Rarely, the intraorbital air mass can cause central retinal artery occlusion. Because of the potential for severe visual loss, the rapid diagnosis and management of this condition are essential. Currently, there is no standard protocol for the treatment and management of severe orbital emphysema. To develop a management algorithm, the authors reviewed the records of eight patients with orbital emphysema, in addition to nine other reported patients with ocular dysfunction. METHODS: Retrospective review of patients with orbital emphysema who have proptosis, diplopia, or loss of vision. RESULTS: Orbital emphysema is associated with small orbital fractures. The location of the intraorbital air mass usually correlates with the fracture location. A four-stage classification system of orbital emphysema is developed. This staging system is helpful in constructing an acute diagnostic and management algorithm for orbital emphysema. CONCLUSION: Understanding the pathophysiology of orbital emphysema is important in developing a rational approach to manage this potentially sight-threatening condition. Treatment using a needle-coupled open syringe filled with saline allows direct monitoring of the air mass during decompression.

Adult↗
PubMed1993

A constitutive form of heat-shock protein 70 is located in the outer membranes of mitochondria from rat liver.

HSP73, the constitutive form of heat-shock protein 70, has been implicated in the translocation of preproteins across the mitochondrial membranes, being required for maintaining mitochondrial preproteins in an import competent conformation. Here we report that highly purified mitochondrial outer membranes contain a protein indistinguishable from HSP73 as a tightly associated peripheral component of the membrane. This membrane form of HSP73 was photolabelled with [alpha-32P]ATP and could be released from the outer membrane with sodium carbonate, but not after incubation of the membranes with salt or with ATP. A sensitive immunoassay with an anti-HSP73 monoclonal antibody, revealed the association of HSP73 with mitochondrial outer membrane vesicles at a level similar to that of preprotein import receptors.

Adenosine Triphosphate↗
PubMed1993

Medial canthotomy and cantholysis in eyelid reconstruction.

Combined medial canthotomy and cantholysis is a quick, technically simple, single-stage reconstructive technique for use in the reconstruction of the upper or lower eyelid. This technique, which transects one lacrimal canaliculus, provides up to 20% of the horizontal eyelid dimension for closure. Medial canthotomy and cantholysis is most frequently used in combination with other eyelid reconstructive techniques for difficult reconstructions, which would otherwise require more extensive surgical procedures. The surgical technique is readily performed with the patient under general anesthesia and entails the transection of one lacrimal canaliculus, lysis of one crus of the medial canthal tendon, and lateral advancement of the medial eyelid stump. We used medial canthotomy and cantholysis in the reconstruction of 29 eyelid defects (21 upper eyelids and eight lower eyelids) over a 12-year period with adequate reconstructive results in all cases. Eleven of the patients underwent simultaneous lateral canthotomy and cantholysis. Complications of the medial canthotomy and cantholysis technique include anterior displacement of the medial portion of the eyelid, epiphora, notching of the medial portion of the eyelid, medial ectropion, and blepharoptosis. If used with appropriate case selection, this technique allows an optimal reconstructive result to be achieved with a minimum of operative time and morbidity.

Eyelid Neoplasms↗
PubMed1993

Whitnall's sling with superior tarsectomy for the correction of severe unilateral blepharoptosis.

The management of severe unilateral blepharoptosis is problematic. In the presence of poor levator function, conventional surgical techniques frequently do not adequately elevate a ptotic eyelid. From May 1988 through July 1991, we used 4- to 5-mm external resections of the superior tarsus in conjunction with a maximal aponeurectomy (Whitnall's sling procedure) to augment blepharoptosis correction in selected cases of severe unilateral blepharoptosis. Seventeen (68%) of 25 patients with poor levator function blepharoptosis who underwent this new surgical procedure achieved a lid height within 1 mm of the opposite lid with good or excellent ocular function, cosmesis, and eyelid crease formation. Mild to moderate degrees of exposure keratopathy developed early in the postoperative period in all patients. This exposure keratopathy ultimately resolved in most patients. Superior tarsectomy safely augments the blepharoptosis correction of a Whitnall sling procedure in severe blepharoptosis, improving the results of aponeurotic surgery in patients with severe unilateral blepharoptosis.

Adolescent↗
PubMed1993

Confounded carcinogenicity study of sodium fluoride in CD-1 mice.

To determine its carcinogenic potential, sodium fluoride (NaF) was fed to CD-1 mice for up to 97 weeks. Mice given NaF at a dose of 4, 10, or 25 mg/kg of body weight per day added to a low-fluoride diet were compared to controls given either an unsupplemented low-fluoride diet or laboratory chow. Nonneoplastic changes consistent with those previously recognized from fluoride toxicity were observed in teeth, bones, and joints. Unexpectedly, osteomas occurred in all groups. The incidence of osteomas was similar in groups given the low-fluoride control diet, laboratory chow, or NaF doses of 4 or 10 mg/kg per day. The incidence of osteomas in these groups was increased over that historically experienced at the laboratory and reported in the literature for CD-1 mice. The incidence of osteomas in the mice given 25 mg NaF/kg per day added to a low-fluoride diet was increased over that in the other groups. Osteomas were first observed at Week 55. No malignant bone tumors were observed during the course of the study. The locations, multiplicity, and morphologic features of the osteomas in all groups were similar to those associated with virus-induced bone tumors. Electron microscopic examination revealed abundant retrovirus particles in all osteomas examined from control and test mice. It was concluded that the study was confounded by a retrovirus which contributed to the induction of the osteomas. Because the study was confounded, it cannot be considered a valid bioassay to be used for risk assessment.

Animals↗
PubMed1993

Auditory brain-stem responses in blepharospasm.

The auditory brain-stem response (ABR) has been reported to detect abnormalities in both the auditory pathways and in adjacent structures. Ten of 35 consecutive patients with blepharospasm were found to have abnormal ABRs involving poor form and delayed peak latency of positive components III or V. Abnormal ABRs in approximately 30% of patients with essential blepharospasm suggest pathology in the brain-stem of a substantial proportion of patients with this form of cranial-cervical dystonia.

Acoustic Stimulation↗
PubMed1993

Orbital meningoencephalocele manifesting as a conjunctival mass.

Orbital meningoencephalocele is a rare congenital abnormality caused by a defect of the cranio-orbital bones that usually manifests soon after birth as a soft, cystic fullness in the superomedial canthal area with associated exophthalmos. We managed an unusual case of congenital orbital meningoencephalocele that manifested as a cystic conjunctival mass without proptosis or periorbital changes. Preoperative computed tomographic scans failed to demonstrate a bone defect. After suture ligature of the posterior stalk, excision of the lesion yielded an ependymal cyst surrounded by neuroglial and meningeal tissue and filled with cerebrospinal fluid. The patient had normal results of ophthalmic and neurologic examinations after transconjunctival resection of the lesion after three years of follow-up. An orbital approach may be appropriate for a few selected cases in which no bone defect is found on computed tomography. Orbital meningoencephalocele should be included in the differential diagnosis of isolated congenital conjunctival cystic masses.

Conjunctival Diseases↗
PubMed1993

Transient myocardial ischemia in infants prenatally exposed to cocaine.

This prospective study examined whether neonates of pregnant women who used cocaine during pregnancy are at a risk for the development of transient myocardial ischemia and altered autonomic function, as in adults. We studied 21 of 35 infants with a history of prenatal exposure to cocaine. The ST segment changes and heart rate variability were evaluated from three-channel Holter monitors within 48 hours of birth. The data were compared with those on 20 control infants with similar birth weight, gestational age, and postnatal age. Six infants (29%) who were exposed to cocaine in utero had transient ST segment elevation, versus only one infant (5%) from the control group (odds ratio = 7.6; 95% confidence interval, 1.14, 50.64). Heart rates, results of total power and low-frequency power spectral analyses for heart rate variability, and arrhythmias were not significantly different in the two groups. However, a lower ratio of low-to high-frequency power reflected increased vagal activity in cocaine-exposed infants. We conclude that cocaine use in pregnant mothers is associated with transient ST segment abnormalities in their infants. These abnormalities are consistent with transient myocardial ischemia.

Cocaine↗
PubMed1993

Invasive squamous cell carcinoma arising from asymptomatic choristomatous cysts of the orbit. Two cases and a review of the literature.

BACKGROUND: Epithelial choristomatous cysts are common orbital lesions, the most frequent of which are dermoid or epidermoid tumors. Massive enlargement or extraorbital extension of these benign lesions may occur. Malignant transformation of the epithelial lining of epidermoid cysts is rarely reported. METHODS: Two patients are presented in whom the epithelial lining of a previously asymptomatic choristomatous cyst of the orbit underwent malignant transformation to produce invasive squamous cell carcinoma. The unusual origin and clinical presentation of the lesions caused a delay in the diagnosis and therapy in both patients. Metastatic workup was negative in both patients, who underwent resection of their tumors via orbital exenteration with craniofacial resection. Reported cases of malignant transformation in analogous choristomatous cysts elsewhere in the cranium are reviewed. RESULTS: One patient is alive and well without recurrent disease 40 months postoperatively. The second patient died of a pulmonary embolus 2 months postoperatively. Autopsy showed no residual tumor. Overall, only 3 of 18 reported patients with epidermoid choristoma of the head and orbit with malignant transformation were alive when reported. CONCLUSIONS: Malignant squamous metaplasia is believed to be a rare complication of orbital dermoid or epidermoid cysts, with only two previously reported cases. However, malignant transformation is relatively frequent in analogous epidermoid cysts found elsewhere in the cranial vault, especially after incomplete excision. These reports encourage the complete removal of epithelial choristomas of the orbit.

Aged↗
PubMed1993

Primary T-cell immunoblastic lymphoma of the orbit in a pediatric patient.

BACKGROUND: The authors report a case of an 8-year-old pediatric patient with a 2-week history of painless periorbital swelling unresponsive to antibiotic treatment. METHODS: Computed tomography (CT) showed a large, lateral, anterior left orbital soft tissue mass with bony erosion into the anterior cranial fossa through the roof of the orbit laterally. Surgical exploration showed a hard white mass that had eroded through the roof of the left orbit and into the anterior cranial fossa, with herniation of the brain and associated dura through the defect. Results of a complete evaluation of the child for systemic lymphoma, including a lumbar puncture, chest x-ray, bone scan, bone marrow aspirate, and chest/abdomen CT, were negative. RESULTS: Results of histopathologic and immuno-histochemical evaluation showed a primary orbital T-cell immunoblastic lymphoma. The patient was treated with intrathecal ara-C (Cytosar-U) and methotrexate, 16.2 Gy of whole brain irradiation, and a chemotherapeutic protocol consisting of cyclophosphamide (Cytoxin), vincristine (Oncovin), methotrexate, daunomycin, and prednisone. The patient remains free of lymphoma 33 months after diagnosis, with 20/20 visual acuity in both eyes. CONCLUSION: The authors believe that this is the youngest documented case of a primary T-cell immunoblastic lymphoma of the orbit.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Hydraulic orbital injection injuries.

BACKGROUND: A high-pressure stream from mechanical equipment may inject gas or liquids deep into the orbit with few initial clinical signs. Aggressive surgical debridement as used in the extremities for the treatment of injection injuries is not possible in the orbit. METHODS: Four patients with orbital injection injuries from farm or industrial equipment are presented. Previously reported cases of high-pressure injection injury are reviewed. RESULTS: Two patients suffered localized anterior orbital inflammation partially responsive to steroidal and nonsteroidal anti-inflammatory agents. Late debridement was required in one patient for a persistent lipogranuloma. Two patients suffered more dramatic and diffuse injections of hydrocarbon mixtures, requiring emergent early surgical debridement and decompression for compressive orbital signs. All patients attained an adequate functional outcome, with one patient's vision limited by a coexisting ocular injury. CONCLUSIONS: High-pressure orbital injection injuries manifest a spectrum of signs ranging from acute inflammation with tissue necrosis and compressive visual loss to late chronic inflammation with a pseudotumor-like course. The authors recommend the initial treatment of orbital injection injuries with systemic antibiotics followed by prompt neuroradiologic imaging. Systemic corticosteroids should be added for confirmed injection injuries with surgical debridement of discrete masses and orbital decompression when indicated. Continued therapy with anti-inflammatory medication may be required to suppress chronic inflammation with selective late surgical debridement of lipogranulomas.

Adult↗