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Biomedical subjects

R S Shapiro

Publications and source records attributed to R S Shapiro.

At least 73 records · Page 4Linked to original sources

Use of an acoustic transponder for US visualization of biopsy needles.

A 20-gauge Chiba needle with a stylet embedded with polyvinyldifluoride (PVDF), a polymer that acts as an acoustic-electric transducer, facilitated a variety of diagnostic and therapeutic ultrasound (US)-guided interventions in nine patients. PVDF receives acoustic energy from the US scanner and transmits an electrical signal through the stylet and a shielded cable to the scanner, which results in appearance of a bright echo on the monitor at the location of the needle tip.

Biopsy, Needle↗

Parry-Romberg syndrome in association with contralateral Poland syndrome.

A 35-year-old woman had a 4-year history of skin depression on the right side of both the forehead and chin. A biopsy specimen showed a normal dermis and an absence of subcutaneous tissue. She also had Poland syndrome on the left side of the body, with loss of the sternocostal portion of the greater pectoral muscle. Significant cosmetic improvement was achieved with dermal fat grafts and silicone implants.

Adipose Tissue↗

Comet-tail artifact from cholesterol crystals: observations in the postlithotripsy gallbladder and an in vitro model.

The "comet tail" is a well-known ultrasound artifact that appears as a series of parallel bands radiating from a source. This artifact was observed in the gallbladder lumen in eight of 10 patients after extracorporeal shock wave lithotripsy of radiolucent calculi. To investigate the cause of the comet tail artifact, cholesterol crystals were studied in an in vitro model. The comet-tail appearance was reproduced in vitro and was found to be directly related to the interrogating frequency and the size of the crystal aggregates. The authors conclude that cholesterol crystals can serve as the source of the comet-tail artifact secondary to reverberation within the crystals.

Cholelithiasis↗

Thyroid dysfunction following bone marrow transplantation: long-term follow-up of 80 pediatric patients.

Thyroid function was evaluated in children surviving disease-free for 2 years or more following bone marrow transplantation (BMT) for severe aplastic anemia (27 patients), acute non-lymphoblastic leukemia (28 patients), and acute lymphoblastic leukemia (25 patients). Pre-BMT conditioning consisted of high dose chemotherapy and total lymphoid irradiation with 750 cGy for patients with severe aplastic anemia, and for patients with leukemia, high dose chemotherapy and single dose total body irradiation with 750-850 cGy (33 patients) or fractionated total body irradiation with 1320 cGy (20 patients). Compensated hypothyroidism (elevated thyroid stimulating hormone (TSH) with a normal thyroxine index) occurred in 20/80 patients with a median time of onset of 12.3 months post-BMT (range 4-30). No patients developed primary hypothyroidism (elevated thyroid stimulating hormone with low thyroxine index). In seven patients, compensated hypothyroidism was transient with TSH returning to normal at a median of 60 months post-BMT (range 11-75). Six patients with compensated hypothyroidism received thyroid hormone replacement therapy. Time to development of compensated hypothyroidism was associated (p = 0.03) with underlying disease and radiation (11 of 27 patients with severe aplastic anemia + total lymphoid irradiation versus nine of 53 patients with leukemia + total body irradiation). In aplastic anemia patients, but not patients with leukemia, the incidence of thyroid hypofunction 5 years post-transplant was significantly higher (p less than 0.001) in those receiving methotrexate alone (82%) as prophylaxis for graft-versus-host disease compared with those receiving a regimen of methotrexate, antithymocyte globulin and prednisone (16%).

Adolescent↗

Expression of Epstein-Barr virus transformation-associated genes in tissues of patients with EBV lymphoproliferative disease.

Epstein-Barr virus (EBV) has been associated with serious or fatal lymphoproliferative disease in immunocompromised patients. EBV nuclear protein 2 and latent membrane protein are characteristically expressed in B lymphocytes proliferating in vitro in response to growth transformation by EBV. These two proteins are thought to be effectors of lymphocyte growth since they increase the expression of B-lymphocyte activation (CD23) and cell-adhesion (LFA 3 and ICAM 1) molecules in vitro. Using monoclonal antibody-immune microscopy, we have demonstrated that these two EBV proteins and their associated B-lymphocyte activation or adhesion molecules are expressed in the infiltrating B lymphocytes in immunocompromised patients with EBV lymphoproliferative disease. These monoclonal antibodies should be useful in the early diagnosis of EBV lymphoproliferative disease and in distinguishing it from other B-lymphocyte cancers associated with EBV, such as Burkitt's lymphoma. The finding of EBV nuclear protein 2 and latent membrane protein and their associated activation or adhesion molecules provides a further pathophysiologic link between EBV and the proliferation of B lymphocytes in immunocompromised patients.

Adult↗

Otologic manifestations in congenital velopharyngeal insufficiency.

A study of ear disease in children with congenital velopharyngeal insufficiency (VPI) was undertaken. A retrospective chart analysis of 80 cases of VPI formed the basis of this review. Thirty-seven percent of the children had evidence of middle ear disease, with middle ear effusion and recurrent otitis media being the most frequent findings. Thirty-one percent had abnormal audiograms, with 20% having a conductive or mixed hearing loss. Overall, 46% of the children had otologic manifestations, indicating the need for the pediatrician and the otolaryngologist together to be actively involved in the evaluation and treatment of this group of children, starting in early infancy.

Adenoidectomy↗

Effects of chronic ochratoxin A and citrinin toxicosis on kidney function of single comb White Leghorn pullets.

The objectives of the present study were to examine the effects of repeated or chronic ochratoxin A (OA) and citrinin exposure, and to determine if severe ochratoxicosis permanently alters renal function in pullets. The OA-treated birds were injected intramuscularly (breast muscle) with a 1 mg/mL solution of OA at a dose of .25 mg/kg BW or .5 mg/kg BW. Citrinin-treated birds were injected with a 6 mg/mL solution of citrinin at a dose of 6 mg/kg BW. Control birds received an equal volume injection of the citrinin and OA solvent, 100% ethanol, at a dose of 1 mL/kg BW. Kidney function was evaluated after 10 consecutive days of OA, citrinin, or ethanol injection, and 2 wk following the final injections. Venous blood gas measurements were taken after the seventh day of injection. The OA increased urine flow rate, decreased urine osmolality, increased ion excretion (Na, K, Ca, P), increased water consumption, increased manure moisture, and caused a relative alkalosis when measured immediately after 10 days of OA injection. These effects of OA were not detected 2 wk later. Citrinin increased manure moisture, decreased plasma P, increased the clearance of para-aminohippuric acid, and had no consistent effect on blood acid-base parameters. The results suggest that OA may cause an osmotic diuresis by inhibiting tubular reabsorption of electrolytes. The data also suggests that the effects of OA may be reversible simply by discontinuing toxin administration. Although the citrinin-induced increase in manure moisture indicates that citrinin had an effect on renal function, renal function analysis suggests that even repeated exposure to high doses of citrinin may only have a short duration of diuretic action on the kidneys.

Analysis of Variance↗

A survey of sued and nonsued physicians and suing patients.

To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians' practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians' practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients' and sued physicians' understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.

Adult↗

Congenital cholesteatoma of the middle ear in children.

Congenital cholesteatoma, once considered to be a rarity, has shown an exponential increase in its incidence as evidenced by numerous clinical studies over the past decade. No explanation has been offered for this phenomenon. A review of the literature indicates that the definition of "congenital cholesteatoma" has strayed from the original one formulated by Derlacki and Clemis, which included a cholesteatoma medial to an intact tympanic membrane, without prior history of aural infections. Allowing patients with recurrent otitis media into studies may have contributed to a "false positive" rise in the incidence of this condition. This article reviews 19 cases of cholesteatomas behind intact tympanic membranes, treated at the Montreal Children's Hospital over a 10-year period. They represent 22% of the entire cholesteatoma population. There appears to be two groups of patients, each with a distinct clinical presentation that correlates well with the surgical outcome. Whether this implies different pathogenetic mechanisms remains unclear.

Adolescent↗