Biomedical subjects
Publications and source records attributed to S Joseph.
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Our experience in the treatment of stenoses of the infrarenal portion of the abdominal aorta with balloon angioplasty in 27 patients is reported. Clinical findings were lower limb claudication (all patients), impotence (eight patients), and blue-toe syndrome (two patients). The underlying disease was atherosclerosis in 24 patients and nonspecific aortoarteritis in three patients. Dilatation was successful in all patients. Embolic occlusions of the left common iliac artery (one patient) and left superficial femoral artery (one patient) were the only major complications. Claudication in the affected limb continued in the first patient; the second died when diagnostic angiography, performed 3 months after angioplasty, caused a severe atheroembolus. Of the other 25 patients, nine of the 10 followed up for 13-48 months and all seven followed up for 3-8 months were free of symptoms. Six of eight patients with sexual dysfunction had normal function after angioplasty. Seven patients still awaited follow-up and one was lost to follow-up. Our experience suggests that balloon angioplasty is an effective treatment of stenoses of the infrarenal portion of the abdominal aorta.
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Highly hydrophilic, perfectly smooth and spherical microspheres have been synthetized. These non-biodegradable microspheres absorb water in varying degrees and can be injected easily through microcatheters due to their slippery and compressible characteristics. The material was successfully used for embolization of 4 vascular intracranial tumours and 2 spinal vascular lesions in the cervical region, by superselective delivery. Histopathology confirmed absolute inertness of the microspheres.
In stimulated human platelets dense-granule secretion in response to the 'weak agonists' ADP, adrenaline, platelet activating factor and low concentrations of thrombin as well as Ca2+ mobilisation in response to thrombin are enhanced by a Na+/H+ exchanger. In the present study the role of this antiport in collagen stimulated human platelets was examined. While stimulation of platelets loaded with the fluorescent intracellular pH-sensitive dye, bis-carboxyethyl-5-(6)-carboxyfluorescein (BCECF) with thrombin resulted in the activation of the Na+/H+ exchanger, activation of this antiport did not occur in collagen-stimulated platelets. The lack of antiport activity in response to collagen using BCECF-loaded platelets correlated with the lack of any functional role of the antiport in collagen stimulated platelets. In the presence of a Na+/H+ exchange inhibitor, ethylisopropylamiloride, neither collagen-induced platelet aggregation or dense-granule secretion was affected. Furthermore, while the removal of extracellular Na+ (Na+ext), a condition that also prevents activation of the antiport, inhibited dense-granule secretion in response to a low concentration of thrombin, collagen-induced secretion was potentiated. This potentiatory effect could not be attributed to changes in either the membrane potential or in collagen-induced phospholipase C or protein kinase C activity. The present results indicate that in contrast to the 'weak agonists' (1) collagen-induced platelet activation does not require activation of the Na+/H+ exchanger and (2) Na+ext per se is an inhibitor of collagen-induced secretion.
Computed tomographic and plain X-ray observations in a patient with corpus callosum lipoma associated with frontal encephalocele are reported. The rarity of the lesion and the specific diagnostic criteria on CT are emphasised.
The clinical and radiological features, and outcome of 30 patients including 22 females, with the aneurysmal form of aortoarteritis were analysed. The average age at diagnosis was 27.4 +/- 7.2 years. Features which indicated the diagnosis of aneurysmal aortoarteritis included young age, female sex, characteristic location, associated stenotic lesions and the presence of multiple aneurysms. There were 41 fusiform and 18 saccular aneurysms, mostly located in the descending aorta. Diffuse dilatation (n = 24) was seen mainly in the ascending aorta. Two patients had dissecting aneurysms, while one patient had an aneurysm of the left main coronary artery. Both these lesions are rare in aortoarteritis. The aneurysmal form was associated with a higher incidence of aortic incompetence (P less than 0.01) and elevated ESR (P less than 0.001) as compared to the more common non-aneurysmal form. The average follow-up period was 59.7 (+/- 48.1) months. The event-free survival rate was 82.9% at 5 years, similar to that seen in the non-aneurysmal form. These data should be useful to the clinician in the diagnosis and management of the aneurysmal form of aortoarteritis.
In five patients embolization of large saccular aneurysms involving the popliteal artery, common carotid artery, arch of the aorta, and abdominal aorta was performed with custom-designed spring coils. Surgery was attempted before embolization for the aneurysm involving the popliteal artery. The other aneurysms were considered nonresectable due to their critical location. Although maximal packing of the aneurysmal sac was attempted, delayed follow-up angiography revealed displacement of the coils away from the parent vessel as well as further expansion of the residual aneurysmal sac. In these cases complete embolization of the aneurysmal sac was not possible without obstructing the parent artery.
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This study focused on a cholesterol screening and education program conducted in Scottsdale, Arizona, to determine the prevalence of hypercholesterolemia among the volunteer participants, and whether such a program motivates lifestyle changes and physician follow-up. The study also examined whether participants used the program to monitor known hypercholesterolemia. During the 6-month program, 1228 individuals were screened. Of these, 29% had a previous history of elevated cholesterol and 5% were on cholesterol-lowering medication. Of the group with no previous history of hypercholesterolemia, 41% had cholesterol levels higher than 5.17 mmol/L (200 mg/dL) and 10% had levels higher than 6.21 mmol/L (240 mg/dL). A subgroup of 120 persons with levels higher than 6.21 mmol/L (240 mg/dL) were contacted 4 to 6 months after the screening. Most of this group reported improvement in diet and exercise patterns, and 58% had consulted a physician. These results suggest that people with known hypercholesterolemia are using community screening programs to monitor their own cholesterol levels, and that such programs identity new high-risk individuals. Program participants appear to change diet and exercise patterns and to seek physician follow-up.
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The authors report the radiological features of a patient, believed to be unique in the literature, of multiple aneurysms of the lateral-most lenticulostriate artery in a normotensive, non-diabetic, young, female patient who presented with left basal ganglionic hematoma and showed spontaneous obliteration of these aneurysms, on follow-up angiography.
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Ninety-five schizophrenic patients were assessed using the Present State Examination, the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Negative and depressive symptoms were frequent, and significant relationships among negative symptom complexes and depressive syndromes were noted. Retardation, lack of energy, slowness, and other symptoms of depression were significantly associated with the negative symptoms of schizophrenia. Depressed affect per se did not have a significant correlation with negative symptoms.
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Of five patients with pervasive developmental disorders (PDDs), four developed psychotic illnesses in adult life. The other was treated with antipsychotic medication for many years following a mistaken diagnosis of schizophrenia.