Asymptomatic giant right atrial myxoma: role of transesophageal echocardiography in management.
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Echocardiography↗
Biomedical subjects
S Smith
Publications and source records attributed to S Smith.
Syndrome of severe skin disease, eosinophilia, and dermatopathic lymphadenopathy in patients with HTLV-II complicating human immunodeficiency virus infection.
Two intravenous drug users dually infected with human immunodeficiency virus type 1 (HIV-1) and human T-cell leukemia virus type II (HTLV-II) developed an unusual severe dermatitis characterized by progressive brawny induration, fissuring, and ulceration of the skin, with an associated CD8 cell infiltration in one patient. Both patients had persistent eosinophilia. Lymph node biopsy revealed dermatopathic lymphadenopathy, an unusual pathologic finding in HIV-1 infection but one seen in association with mycosis fungoides and other skin disorders. Two new isolates of HTLV-II virus were established from these patients and were identified as HTLV-II by Southern blotting. This type of skin disease and lymph node pathology has not been found in other intravenous drug users who have been infected with HIV-1 alone or in patients in other risk groups for HIV-1 infection. HTLV-II may play a role in this unique new disease pattern in patients infected with HIV-1.
Adult↗
Phase II study of the amsacrine analogue CI-921 (NSC 343499) in non-small cell lung cancer.
CI-921 (NSC 343499; 9-[[2-methoxy-4-[(methylsulphonyl)amino]phenyl]amino] -N,5-dimethyl- 4-acridinecarboxamide) is a topoisomerase II poison with high experimental antitumour activity. It was administered by 15 min infusion to 16 evaluable patients with non-small cell lung cancer (NSCLC) (7 with no prior treatment, 9 patients in relapse following surgery/radiotherapy) at a dose (648 mg/m2 divided over 3 days, repeated every 3 weeks) determined by phase I trial. Patients had a median performance status of 1 (WHO), and median age of 61 years. The histology comprised squamous carcinoma (11), adenocarcinoma (1), mixed histology (2), bronchio-alveolar carcinoma (1) and large cell undifferentiated carcinoma (1). Neutropenia grade greater than or equal to 3 was seen in 15 patients, infections with recovery in 3, and grand mal seizures in 1 patient. Grade less than or equal to 2 nausea and vomiting occurred in 66% courses and phlebitis in the infusion arm in 37%. 1 patient with squamous cell carcinoma achieved a partial response lasting 5 months. Further testing in this and other tumour types using multiple daily schedules is warranted.
Adult↗
Localization of 616 human chromosome 3-specific cosmids using a somatic cell hybrid deletion mapping panel.
A total of 5700 human chromosome 3-specific cosmid clones was isolated from a series of cosmid libraries constructed from somatic cell hybrids whose only human component was an entire chromosome 3 or a chromosome 3 containing an interstitial deletion removing 50% of long arm sequences. Several unique sequence chromosome 3-specific hybridization probes were isolated from each of 616 of these cosmids. These probes were then used to localize the cosmids by hybridization to a somatic cell hybrid deletion mapping panel capable of resolving chromosome 3 into nine distinct subregions. All 616 of the cosmids were localized to either the long or short arm of chromosome 3 and 63% of the short arm cosmids were more precisely localized. We have identified a total of 87 cosmids that contain fragments that are evolutionarily conserved. Fragments from these cosmids should prove useful in the identification of new chromosome 3-specific genes as well as in comparative mapping studies. The localized cosmids should provide excellent saturation of human chromosome 3 and facilitate the construction of physical and genetic linkage maps to identify various disease loci including Von Hippel Lindau disease and renal and small cell lung carcinoma.
Animals↗
High-density molecular map of the central span of the mouse X chromosome.
A total of 17 linking clones previously sublocalized to the central span of the mouse X chromosome have been ordered by detailed analysis through interspecific Mus spretus/Mus musculus domesticus backcross progeny. These probes have been positioned with respect to existing DNA markers utilizing a new interspecific backcross segregating for the Tabby (Ta) locus. The density of clones within this 11.5-cM interval is now, on average, one clone every 1000 kb. This high-density map provides probes in the vicinity of a number of important genetic loci in this region which include the X-inactivation center, the Ta locus, and the mottled (Mo) locus, and therefore provides a molecular framework for identification of the genes encoded at these loci.
Animals↗
A clinical nurse specialty could benefit your program.
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Aircraft↗
Human papillomavirus segregation patterns in genital and nongenital warts in prepubertal children and adults.
This study compared the segregation patterns of human papillomavirus (HPV) in genital and nongenital warts in prepubertal children and adults. HPV 2 was detected in most nongenital warts in children and adults, whereas neither HPV 6 or 11 was detected at nongenital sites in either group with the use of in situ or Southern blot hybridization analyses. Of nine genital tract lesions in children. HPV 2 was detected in two and HPV 6 or 11 in six. More than 90% of cases of regional tract condylomata in adults contained HPV 6 or 11. HPV 2 was not detected in any of 99 genital tract lesions in adults. It is concluded that HPV 6/11 cannot proliferate at nongenital cutaneous sites and HPV 2 can proliferate in the genital tract of children but not adults. Thus, the detection of HPV 6 or 11 in a genital wart in a child implies, assuming cutaneous transmission, infection from a genital site, whereas the detection of HPV 2 presumes nongenital transmission.
Adult↗
Audit of user satisfaction with the Leicestershire Breast Screening Service; women attending for assessment of abnormal mammograms.
Women returning for assessment of abnormal breast screens completed user satisfaction questionnaires: 103 at the clinic (100 per cent response) and 79 (87 per cent) of 91 without malignancies a week later. Women were satisfied with invitations' timing and with the information in one of three letter versions tested. A small group (11 per cent) had not discussed their invitations with anybody and also declined to do so with the Breast Care Sister. Twenty-nine per cent of women had to wait longer than 15 minutes (longer than expected for nine of them). Most women (69 per cent) described the staff as the best aspect of their visit, 55 per cent found nothing unpleasant and 96 per cent said they would attend again. Others mentioned waiting, the dressing gowns and the mammography as unpleasant. The audit allowed the service to be improved and provided invaluable feedback to staff working in a stressful environment. Similar audits will be repeated when screening other Leicestershire areas.
Anxiety↗
The effect of apnea on brain compliance and intracranial pressure.
The effect of 2 minutes of apnea during endotracheal intubation on intracranial pressure (ICP), compliance, and cerebral blood volume (CBV) was studied in 19 adult dogs during normo-, hypo-, and hypercapnia. The compliance was measured from the cisterna magna in response to an intrathecal bolus injection (pressure-volume index). CBV was monitored by radiolabeled red blood cell activity. These measurements were made before and after 2 minutes of apnea. At normocapnia (pCO2 of 35-40 mm Hg), a period of apnea resulted in an increase in ICP from 9.6 to 26.3 mm Hg, a decrease in compliance from 0.051 to 0.020 ml/mm Hg (60%), and an increase in CBV of 0.26 ml (9.6%). When the animals were hypocapnic (pCO2 of 24-28 mm Hg), ICP increased from 12.8 to 19.6 mm Hg, compliance fell from 0.041 to 0.029 ml/mm Hg(29%), and CBV increased 0.07 ml (3.1%). Hypercapnia (pCO2 of 50-58 mm Hg) before apnea resulted in an increase in ICP from 21.5 to 47.1 mm Hg, a decrease in compliance from 0.032 to 0.015 ml/mm Hg (52%), and an increase in CBV of 0.41 ml (13.4%). These results suggest that hyperventilation (hypocapnia) before intubation limits the adverse decrease in brain compliance and increase in ICP by reducing changes in cerebral blood volume.
Animals↗
Bacterial colonization of tunneled right atrial catheters in pediatric oncology: a comparison of sterile saline and bacteriostatic saline flush solutions.
In a double-blind, randomized controlled trial, children with malignant diseases had their tunneled right atrial catheters flushed with either sterile saline or bacteriostatic saline, once per week for 26 weeks. There was no significant difference in the rates of catheter colonization between the two groups, which did differ, however, in terms of the time from entry into the study to the first infective event (64 +/- 34 days vs. 146 +/- 27 days; p less than 0.001). This was strongly suggestive of a seasonal effect, as all of the colonizations in the bacteriostatic saline group were delayed until the summer months. We conclude that the use of a bacteriostatic saline flush solution for tunneled right atrial catheters is beneficial in efforts to prevent catheter colonization.
Bacterial Infections↗
Maintenance of the patency of indwelling central venous catheters: is heparin necessary?
The use of indwelling central venous catheters for the ambulatory management of children with cancer has been well described. There remains uncertainty as to the best method for maintaining the patency of these catheters. The standard approach at our institution is to flush the catheter twice daily with a solution containing heparin. This is both costly and inconvenient for most families. We describe a randomized cross-over study designed to compare the standard approach to a less intense program using an isotonic saline flush once a week. Evaluation continued for approximately 1,515 days in each study arm. The catheters were monitored for blockage, clot formation, and infection. One catheter blocked in a patient receiving the experimental method of care. Two episodes of thrombus formation were demonstrated at the end of the study (one in each of the study arms). The incidence of infection, while in keeping with our overall experience, was higher in the experimental arm. This led to a subsequent study, reported separately in this symposium. The results indicate that there is no significant difference, in the incidence of blocked catheters or other complications, between the two forms of care.
Adolescent↗
Model studies of extracellular electrograms arising from an excitation wave propagating in a thin layer.
Extracellular potentials were calculated for a wave of activation propagating through a thin layer of tissue. Sources were represented on the basis of the bidomain model, with the observation point at the tissue surface. Calculated potentials were found to be insensitive to the length of the wavefront if it passed under the recording electrode provided its length exceeded 1 mm, but to decrease rapidly when the wave passed to a side of the electrode. Contributions of source regions with a lateral displacement from the electrode greater than about 0.3 mm were substantially diminished. The effects of the thickness of the layer and velocity of propagation on amplitude was investigated.
Action Potentials↗
Suicidal ideation: its enduring nature and associated morbidity.
A longitudinal study between 1980 and 1988 of school leavers entering adulthood examined suicidal ideation 4 and 8 years after an initial battery of psychological tests. The report of suicidal ideation during their lives was significantly associated with measures of depression, self-esteem and locus of control 8 years previously. It was also associated with those measures as well as anomie, hopelessness and scores on the General Health Questionnaire 4 years previously. These associations were not as strong for subjects whose suicidal ideation had been present in the most recent 6 months, or for those who acknowledged having attempted suicide. No fewer than 40% of subjects who acknowledged suicidal ideation when examined in 1984 denied ever having had suicidal ideation during their lives when re-examined in 1988. This raises doubts about the validity of such studies. Although these findings provide data that confirm the enduring nature of suicidal ideation and its continuing morbidity, they do not give confidence that any screening of schoolchildren could actually predict those who will attempt suicide. Such studies cannot replace full clinical assessment of individual suicidal subjects.
Adolescent↗
Genetic characterization of a novel familial dementia.
Clinical and neuropathologic findings from a Danish family in which a dementing illness is segregating as an apparent autosomal dominant disorder were previously described (Gydesen et al. 1987). We present here genetic findings from this family in which linkage analysis has excluded Huntington's disease and chromosome 21-encoded Alzheimer's disease. None of the known prion mutations has been detected in affected individuals from this family. However, linkage analysis with the prion gene has been uninformative. This family probably represents a novel genetic dementia.
DNA Probes↗
Haematological and biochemical reference values for grazing Saanen goats.
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Animals↗
Relationships between mental adjustment to HIV diagnosis, psychological morbidity and sexual behaviour.
This paper examines patterns of psychological adjustment in a small sample of asymptomatic HIV antibody positive men. Comparison is made with data available on male cancer patients. HIV positive men reported greater degrees of anxious preoccupation and hopelessness, and lower levels of the more adaptive 'fighting spirit' response. In HIV-infected men, depression correlated positively with frequency of high risk sexual practices.
Adaptation, Psychological↗
Allograft aortic valve replacement: long-term comparative clinical analysis of the viable cryopreserved and antibiotic 4 degrees C stored valves.
Aortic valve replacement with or without concomitant procedures was performed using an allograft aortic valve in 534 patients. From December 1969 to May 1975 (group I), a 4 degrees C stored valve was used (124 patients) and from June 1975 to July 1990 (group II), a cryopreserved valve (410 patients) was used. The 30-day mortality was 8.9% (confidence limits [CL] 6.2%-12.3%) for group I and 2.7% (CL 1.9%-3.8%) for group II. Actuarial patient survival including early hospital mortality at 14 years was 57% for group I and 71% for group II (p = 0.014). Actuarial freedom from thromboembolism for all patients (n = 534) was 94% at 14 years, and for patients who underwent isolated aortic valve replacement with or without coronary artery bypass graft (n = 457) was 97% at 14 years (p = 0.017). Actuarial freedom from allograft valve endocarditis at 14 years was 92% in group I and 94% in group II (p = 0.36). The actuarial freedom from moderate or severe allograft valve incompetence at 14 years was 50% (group I) and 78% (group II) (p = 0.27). Reoperation was undertaken for endocarditis, leaflet structural deterioration (SD), or technical reasons. The actuarial freedom from reoperation (all causes) at 14 years was 63% (group I) and 86% (group II) (p = 0.39). Reoperation for SD occurred in 34 patients in group I and three patients in group II. The actuarial freedom from reoperation for SD at 14 years was 67% (group I) and 95% (group II) (p = 0.001). To reflect a more accurate depiction of the prevalence of SD, patients were analyzed according to the development of "assumed structural deterioration" (at reoperation, at death with moderate or severe allograft valve incompetence and macroscopic valve deterioration on autopsy, and in the presence of moderate or severe allograft valve incompetence in patients not undergoing reoperation). The actuarial freedom from "assumed structural deterioration" at 14 years was 51% (group I) and 85% (group II) (p = 0.000003). The long-term results confirm the low incidence of thromboembolism and endocarditis regardless of the method of preservation and demonstrate the overall acceptable performance of the viable cryopreserved allograft valve and its superiority over the 4 degrees C stored valve.
Actuarial Analysis↗
Biologic markers in risk assessment for environmental carcinogens.
The potential of biologic markers to provide more timely and precise risk assessments for environmental carcinogens is viewed against the current state-of-the-art in biological monitoring/molecular epidemiology. Biologic markers such as carcinogen-DNA adducts and oncogene activation are currently considered valid qualitative indicators of potential risk, but for most chemical exposures research is needed to establish their validity as quantitative predictors of cancer risk. Biologic markers have, however, already provided valuable insights into the magnitude of interindividual variation in response to carcinogenic exposures, with major implications for risk assessment.
Bias↗