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Biomedical subjects

S Snow

Publications and source records attributed to S Snow.

At least 19 recordsLinked to original sources

Renal cell carcinoma metastatic to the scalp: case report and review of the literature.

BACKGROUND: Renal cell carcinoma metastatic to the skin is rare. OBJECTIVE: To illustrate by a case report the clinical presentation and management of the disease. METHODS: We present a case of renal carcinoma metastatic to the skin of the scalp that occurred 6 years after removal of her kidney. The tumor was diagnosed using frozen tissue and paraffin sections. RESULTS: Cutaneous metastasis treated by excision. CONCLUSION: Renal cell carcinoma may metastasize to the skin of the scalp. Our case illustrated an interesting ipsilateral metastasis that occurred 6 years after treatment of her primary tumor. Physicians, dermatologists, pathologists, and Mohs surgeons should be aware of this entity.

Aged↗

Microcystic adnexal carcinoma: report of 13 cases and review of the literature.

BACKGROUND: Microcystic adnexal carcinoma (MAC) is a rare tumor of the skin. Clinically it often masquerades as a firm, subcutaneous nodule on the head and neck regions. Microscopically it extends far beyond assessed clinical margins spreading locally in the dermal, subcutaneous, and perineural tissue planes. The local recurrence rate by standard excision is about 50%. Recent preliminary reports indicate more favorable cure rates with Mohs micrographic surgery (MMS). OBJECTIVE: To present our data on 13 cases (12 patients) of MAC treated by MMS. In addition, we reviewed the medical literature to summarize the accumulated experience of MMS treatment in the management of MAC. We also present a case of bilateral MAC of the face and describe a renal transplant recipient on immunosuppressive therapy who developed MAC of the nasal bridge. METHODS: We reviewed and updated our series of MAC cases treated by MMS over the last 9 years. A total of 13 cases of MAC are reviewed. We also searched the literature for MAC treated by MMS with a follow-up of more than 2-years. RESULTS: One patient had bilateral MAC of the nose and cheek. Another patient developed a MAC of the nasal bridge 20 years after renal transplantation. In this patient predisposing factors were radiation for teenage acne and immunosuppression therapy. A total of 13 cases of MAC were treated by MMS with no recurrences, with a mean follow-up of 5.0 years (range 1.1-8.0 years). CONCLUSION: We update the medical literature with 13 MAC cases treated by MMS. To our knowledge there have been 148 cases of MAC reported in the world literature. Including our series, there have been 73 cases of MAC treated with MMS. There were only four treatment failures. Regional and/or distant metastasis from MAC is rare, with only one reported death. Following MMS, the 2-year success rate was 89.7% (35 of 39). The accumulated data continue to confirm that when MAC is discovered early and is readily accessible to excision by MMS and other subspecialty support, a favorable outcome can be expected.

Adult↗

Phase I chemoprevention study of difluoromethylornithine in subjects with organ transplants.

Individuals who receive life-saving organ transplants and the required immunosuppression often develop secondary cancers. One of the most common secondary cancers is nonmelanoma skin cancer in sun-exposed areas. Attempts to prevent these cancers have not been successful. Difluoromethylornithine (DFMO), a suicide inhibitor of ornithine decarboxylase (ODC), is a known experimental cancer prevention agent that is being evaluated in a number of human cancer prevention trials. This report describes a Phase I trial in 18 organ transplant recipients, randomized to 1.0 and 0.5 g of DFMO or a placebo, designed to look at short-term toxicities over 28 days as well as the impact of DFMO on two biological parameters, skin polyamines and 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced ODC activity. Blood levels of DFMO were also measured. The results indicate that DFMO was well tolerated over the 28-day period. The TPA-induced ODC activity in 3-mm skin biopsies was significantly lowered by 80 and 67% at the two dose levels. Polyamine levels were not affected significantly except for putrescine at the 0.5-g level. Blood levels of DFMO were about two times higher than expected, based on our prior pharmacokinetic studies. Our studies indicate that DFMO is a reasonable agent that should be tested further in larger Phase 2b trials in this population as a chemopreventive agent. TPA-induced ODC activity appears to be a relevant intermediate biological assay.

Adult↗

Risk factors for the incidence and progression of radiographic knee osteoarthritis.

OBJECTIVE: Preventive strategies against knee osteoarthritis (OA) require a knowledge of risk factors that influence the initiation of the disorder and its subsequent progression. This population-based longitudinal study was performed to address this issue. METHODS: Ninety-nine men and 255 women aged > or =55 years had baseline interviews and weight-bearing knee radiographs in 1990-1991. Repeat radiographs were obtained in 1995-1996 (mean followup duration 5.1 years, median age at followup 75.8 years). Risk factors assessed at baseline were tested for their association with incident and progressive radiographic knee OA by logistic regression. RESULTS: Rates of incidence and progression were 2.5% and 3.6% per year, respectively. After adjusting for age and sex, the risk of incident radiographic knee OA was significantly increased among subjects with higher baseline body mass index (odds ratio [OR] 18.3, 95% confidence interval [95% CI] 5.1-65.1, highest versus lowest third), previous knee injury (OR 4.8, 95% CI 1.0-24.1), and a history of regular sports participation (OR 3.2, 95% CI 1.1-9.1). Knee pain at baseline (OR 2.4, 95% CI 0.7-8.0) and Heberden's nodes (OR 2.0, 95% CI 0.7-5.7) were weakly associated with progression. Analyses based on individual radiographic features (osteophyte formation and joint space narrowing) supported differences in risk factors for either feature. CONCLUSION: Most currently recognized risk factors for prevalent knee OA (obesity, knee injury, and physical activity) influence incidence more than radiographic progression. Furthermore, these factors might selectively influence osteophyte formation more than joint space narrowing. These findings are consistent with knee OA being initiated by joint injury, but with progression being a consequence of impaired intrinsic repair capacity.

Aged↗

Vulvar squamous cell carcinoma metastatic to the skin.

BACKGROUND: Cutaneous metastases from vulvar squamous cell carcinomas (SCC) have been reported only twice previously and both patients expired shortly after they occurred. Mohs surgery has been reported in three previous publications as a successful treatment for local invasive vulvar SCC and Bowen's disease. OBJECTIVE: To describe a third case with cutaneous metastases and 14 other cases of invasive and in situ vulvar SCC treated by fresh tissue Mohs surgery in a pilot study at the University of Wisconsin between 1976 and 1995. METHODS: We took photographs of the gross appearance and of the histologic slides of the tumor at the local site and at the metastatic sites on the skin and reviewed patients' charts. RESULTS: One patient developed pelvic and cutaneous metastases 5 years after radical vulvectomy with bilateral node dissection. She expired shortly after the skin metastases appeared. The courses of the patients followed after Mohs surgery for vulvar SCC were variable. CONCLUSIONS: Cutaneous metastases from vulvar SCC are rare but carry a grim prognosis. Mohs surgery should be considered in select cases to try to prevent excess morbidity and mortality.

Aged↗

Protein structural plasticity exemplified by insertion and deletion mutants in T4 lysozyme.

To further investigate the ways in which proteins respond to changes in the length of the polypeptide chain, a series of 32 insertions and five deletions were made within nine different alpha-helices of T4 lysozyme. In most cases, the inserted amino acid was a single alanine, although in some instances up to four residues, not necessarily alanine, were used. Different insertions destabilized the protein by different amounts, ranging from approximately 1 to 6 kcal/mol. In one case, no protein could be obtained. An "extension" mutant in which the carboxy terminus of the molecule was extended by four alanines increased stability by 0.3 kcal/mol. For the deletions, the loss in stability ranged from approximately 3 to 5 kcal/mol. The structures of six insertion mutants, as well as one deletion mutant and the extension mutant, were determined, three in crystal forms nonisomorphous with wild type. In all cases, including previously described insertion mutants within a single alpha-helix, there appears to be a strong tendency to preserve the helix by translocating residues so that the effects of the insertion are propagated into a bend or loop at one end or the other of the helix. In three mutants, even the hydrophobic core was disrupted so as to permit the preservation of the alpha-helix containing the insertion. Translocation (or "register shift") was also observed for the deletion mutant, in this case a loop at the end of the helix being shortened. In general, when translocation occurs, the reduction in stability is only moderate, averaging 2.5 kcal/mol. Only in the most extreme cases does "bulging" or "looping-out" occur within the body of an alpha-helix, in which case the destabilization is substantial, averaging 4.9 kcal/mol. Looping-out can occur for insertions close to the end of a helix, in which case the destabilization is less severe, averaging 2.6 kcal/mol. Mutant A73-[AAA] as well as mutants R119-[A] and V131-[A], include shifts in the backbone of 3-6 A, extending over 20 residues or more. As a result, residues 114-142, which form a "cap" on the carboxy-terminal domain, undergo substantial reorganizations such that the interface between this "cap" and the rest of the protein is altered substantially. In the case of mutant A73-[AAA], two nearby alpha-helices, which form a bend of approximately 105 degrees in the wild-type structure, reorganize in the mutant structure to form a single, essentially straight helix. These structural responses to mutation demonstrate the plasticity of protein structures and illustrate ways in which their three-dimensional structures might changes during evolution.

Amino Acid Sequence↗

Intake of non-starch polysaccharide (dietary fibre) in edentulous and dentate persons: an observational study.

Compromised masticatory efficiency places edentulous persons at risk of consuming a diet low in non-starch polysaccharide (NSP) ('dietary fibre'). No study has quantified NSP intake in edentulous people using a valid and reliable method of dietary assessment. The aim of this study was to provide quantitative data on NSP intake of edentulous persons, together with information on its dietary sources. Using the dietary history method, habitual intake of NSP was compared between edentulous persons (n = 30) and dentate persons (n = 30) between the ages of 40 and 60. Groups were matched for sex and social class. The edentulous group had a median NSP intake of 73 (31-211) g/week. This was significantly lower than that of the dentate group of 106 (25-225) g/week (P = 0.014). Neither group completely met current UK guidelines. NSP intake of 56% (n = 17) of the edentulous group was below 84 g/week, whilst 17% (n = 5) of the dentate group was below this figure--a level of intake below which increased occurrence of gastrointestinal complaints has been observed. The dentate group obtained significantly more NSP from all rich sources, including wholemeal breads, cereals, vegetables and fruit. Depending on their form and preparation, such foods are not necessarily difficult to chew. Specific advice on food selection is required to ensure the edentulous patient has an adequate intake of NSP. Education of the dentist for this purpose is of paramount importance.

Adult↗

Sensitization to cocaine's motor activating properties produced by electrical kindling of the medial prefrontal cortex but not of the hippocampus.

A substantial body of evidence has accumulated that implicates NMDA systems in the neural changes that are associated with the development of both electrical kindling of limbic sites and sensitization to the behavioral effects of repeated stimulant exposure. This study sought to establish whether electrical kindling of the brain was a sufficient condition for inducing sensitization to cocaine's motor activating effects and, if so, whether the cross sensitization was a result of kindling of a specific locus. Rats received daily electrical stimulation of either the medial prefrontal cortex or the hippocampus. Other rats received the electrode implants and were handled daily but received no electrical stimulation. Stage 5 seizures developed in response to the stimulation in 32-35 days. Once this criterion of kindling was established and following a 14 day waiting period the effectiveness of cocaine (0.0, 5.0 or 10.0 mg/kg) in elevating horizontal motor activity was determined. For all 3 groups (sham controls, prefrontal cortical and hippocampal stimulated rats) cocaine produced a dose-dependent increase in horizontal activity. The sham controls and hippocampal rats did not differ in the magnitude of the cocaine-produced effect. However, rats that had received stimulation of the prefrontal cortex showed heightened levels of cocaine-induced activity that were particularly apparent in response to 10.0 mg/kg cocaine. These data suggest that kindling of the prefrontal cortex had sensitized rats to the behavioral effects of cocaine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Overall long-term impact of total hip and knee joint replacement surgery on patients with osteoarthritis and rheumatoid arthritis.

All patients with OA or RA entering an orthopaedic waiting list for total hip or knee replacement surgery over a period of 2.5 yr were prospectively assessed for overall pain (Visual Analogue Scale) and disability (Health Assessment Questionnaire) prior to and following their operation at annual intervals for up to 5 yr. A total of 293 patients had 335 operations (OA, hip 164; OA, knee 76; RA, hip 41; RA, knee 54). A few patients (14) showed a deterioration in pain and function 1 yr after surgery, but the remainder showed improvements which took 1 yr or more to reach maximum and were maintained for at least 3 yr. Although greater for OA hip patients, improvements occurred and were maintained in all groups, in spite of the polyarticular nature of RA.

Aged↗

Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever.

BACKGROUND: The incidence of acute rheumatic fever in New Zealand remains relatively high. Reliable early diagnosis of carditis is difficult and important in management. AIM: To determine if Doppler echocardiography contributed to the early diagnosis of carditis in acute rheumatic fever. METHODS: Forty-seven patients admitted to hospital with suspected acute rheumatic fever and 19 control patients, with a febrile illness due to a documented non-cardiac bacterial infection, were assessed two days and two weeks following admission. Presence or absence of clinical carditis was determined by a cardiologist unaware of the suspected diagnosis, from clinical examination, chest radiograph, electrocardiogram (ECG) and two dimensional echocardiogram. Doppler echocardiography was then performed and interpreted by a second cardiologist unaware of the diagnosis. After completion of the study the Jones criteria were applied, to categorise the patients with suspected acute rheumatic fever into four groups for the final diagnosis: no acute rheumatic fever, possible acute rheumatic fever, definite acute rheumatic fever without carditis, and definite acute rheumatic fever with carditis. RESULTS: In 19 patients with a final diagnosis of acute rheumatic fever and carditis at the baseline assessment carditis was detected by clinical assessment in 15 patients, compared with 19 patients with evidence of significant valve regurgitation by Doppler echocardiography. Following the two week assessment, all 19 patients had both clinical and Doppler evidence of carditis. Five patients with a final clinical diagnosis of possible acute rheumatic fever or definite acute rheumatic fever without carditis, had a Doppler abnormality detected. There was no clinical or Doppler abnormality in the febrile controls. CONCLUSIONS: Doppler echocardiography is more sensitive than clinical assessment in the detection of carditis in acute rheumatic fever, and can contribute to earlier diagnosis.

Acute Disease↗

Mechanical and constitutional risk factors for symptomatic knee osteoarthritis: differences between medial tibiofemoral and patellofemoral disease.

OBJECTIVE: The generation of effective preventive strategies against knee osteoarthritis (OA) requires precise understanding of the individual risk factors for the condition. To identify these risk factors, we performed a population based case-control study of the disorder. METHODS: We compared 109 men and women with symptomatic, radiographically verified OA in the tibiofemoral (TFJ) and/or patellofemoral (PFJ) compartments of the knee joint with 218 community controls matched for age and sex. Information on risk factors was obtained by a structured interview and examination. RESULTS: Independent risk factors for knee OA included obesity (odds ratio [OR] 3.3; 95% confidence intervals [95% CI] 1.6-6.9), previous knee injury (OR 3.4; 95% CI 1.7-6.7), meniscectomy (OR 4.0; 95% CI 1.0-16.4), family history (OR 2.7; 95% CI 1.3-5.5) and Heberden's nodes (OR 2.0; 95% CI 1.1-3.6). Obesity and meniscectomy were stronger risk factors for medial TFJ disease, while Heberden's nodes and family history were more closely associated with PFJ involvement. CONCLUSION: Although based on small numbers, our results suggest that the relative contribution of mechanical and constitutional factors in the pathogenesis of OA in different compartments of the knee joint might vary. They also confirm the importance of significant knee injury and meniscectomy as risk factors for medial TFJ disease in the general population.

Aged↗

Results of treatment of severe carpal tunnel syndrome.

A retrospective study was undertaken to determine the efficacy of carpal tunnel decompression in patients with advanced carpal tunnel syndrome. The criteria for inclusion in this study were unobtainable median sensory-evoked response and absent or prolonged median motor distal latency. Fifteen hands in 13 patients met these criteria. All patients had symptoms, including pain, weakness, or decreased sensation. Postoperative follow-up averaged 27 months. Symptomatic improvement was obtained in 14 of the 15 hands, and sensory-evoked response improved in 13 hands. Preoperative thenar atrophy was present in 10 of the 15 hands and was completely resolved in 2 of the 10 patients. These results indicate that carpal tunnel decompression is of benefit to patients with severe carpal tunnel syndrome. Long-standing symptoms, thenar atrophy, virtual anesthesia, and the absence of demonstrable sensory and motor-evoked responses are not contraindications to surgery.

Aged↗

Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint.

The intimate relation which the patella has with the knee joint and quadriceps muscle suggests that patellofemoral joint osteoarthritis is likely to be an important cause of knee pain and disability. Two hundred and seventy three subjects who reported knee pain in a postal questionnaire survey and 240 control subjects consented to have anteroposterior weightbearing and lateral knee radiographs. Each subject completed a Stanford Health Assessment Questionnaire (HAQ). Radiographic knee osteoarthritis was found in 53% of symptomatic and 17% of asymptomatic subjects. Three patterns predominated patellofemoral, medial, and medial/patellofemoral joint disease in 11, 21, and 7% of the men and in 24, 12, 6% of the women respectively. The occurrence of isolated symptomatic patellofemoral joint osteoarthritis in this sample aged more than 55 years was estimated as 8% in women and 2% in men. All patterns of symptomatic knee joint osteoarthritis increased with age in women but peaked at 70 years in men. Medial joint and patellofemoral joint osteoarthritis were significantly associated with disability (46 v 17% in controls and 64 v 25% in controls respectively) but higher HAQ scores were more common in subjects with patellofemoral joint osteoarthritis. Patellofemoral joint osteoarthritis is common, associated with disability, occurs in the absence of tibiofemoral disease, and can no longer be omitted from future studies of osteoarthritis of the knee joint.

Age Factors↗

Pre-exposure to amphetamine but not nicotine sensitizes rats to the motor activating effect of cocaine.

Rats were pretreated with nine daily injections of either d-amphetamine SO4(1.0 mg/kg, 1P), nicotine bitartrate (0.6 mg base/kg, SC) or saline. The motor activating effects of these drugs were measured for 60 min postinjection. On the tenth day, they were given a challenge injection of cocaine HCl (10 mg/kg) or saline and activity was again measured for 60 min postinjection. Both amphetamine and nicotine enhanced motor activity, although the stimulating effect of nicotine was not apparent until the third exposure to the drug. When the response to cocaine was assessed in these pre-exposed rats, only the amphetamine-treated animals were sensitized; they demonstrated a greater cocaine-induced motor activation than their saline-pretreated counterparts. The nicotine pre-exposed rats failed to demonstrate sensitization to the behavioral effect of cocaine; their response was not greater than the rats that had received pre-exposure to saline. These data demonstrate that the response to cocaine can be influenced by prior drug experience and that the influence may be dependent on the neurochemical specificity of the drug.

Amphetamine↗