Search PubMed⌕ Search

Biomedical subjects

W R Marsh

Publications and source records attributed to W R Marsh.

68 records · Page 4Linked to original sources
PubMed1986

Inflammation and the late phase reaction in asthma: the effect of polymorphonuclear leukocyte depletion on airways obstruction and bronchial hyperreactivity in an animal model.

Increases in airway reactivity noted after antigen exposure in which a late asthmatic response (LAR) develops may be related to pulmonary inflammation. Employing an animal model of the LAR developed in our laboratory, we conducted experiments to determine if depletion of polymorphonuclear leukocytes (PMLs) would ablate the LAR and inhibit subsequent increases in airways reactivity. Four groups of ten animals each were studied. The first group was given immune sera (I) containing anti-ragweed IgE. The second group received non-immune sera (NI). A third group of animals received immune sera plus nitrogen mustard (I + NM), while a fourth group received non-immune sera plus nitrogen mustard (NI + NM). Airways reactivity to histamine and the evaluation of different cell types in bronchoalveolar lavage fluid (BALF) were determined three days before and three days after bronchial challenge with ragweed extract (RWE). No control rabbit (NI or NI + NM) developed either an immediate asthmatic response (IAR) or an LAR, and no significant increases occurred in their airways reactivity or cells in lavage fluid after bronchial challenge with RWE. In contrast, the sensitised rabbits not given nitrogen mustard developed an LAR and airways reactivity increased markedly three days later. Those animals receiving immune sera and nitrogen mustard developed an IAR; however, no LAR occurred and no significant change in airways reactivity ws observed. BALF analysis seventy-two hours after ragweed challenge in the animals that received immune sera showed a significant increase in PMLs. However, there was no significant increase on BALF PMLs in the animals receiving immune sera and nitrogen mustard.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Obstruction↗
PubMed1985

Increases in airway reactivity to histamine and inflammatory cells in bronchoalveolar lavage after the late asthmatic response in an animal model.

An increase in airway reactivity after the late asthmatic response (LAR) has been noted in humans. Although these alterations in reactivity have been proposed to be associated with inflammation, no clinical study of the LAR has shown both increased airway reactivity and evidence of pulmonary inflammation. Employing an animal model of the LAR in rabbits developed in our laboratory (Am Rev Respir Dis 1982; 126:493-498), we examined changes in airway reactivity and pulmonary inflammation in rabbits having a late asthmatic response. Two groups of rabbits were studied: a control group (n = 10) received nonimmune serum, and a sensitized group (n = 10) received serum containing homocytotropic antibody (IgE) to ragweed extract (RWE) from rabbits previously immunized from birth with ragweed. Airway reactivity to histamine and the evaluation of different cell types in bronchoalveolar lavage fluid were determined 3 days before and 3 days after bronchial challenge with RWE in all rabbits. No control rabbit developed a LAR, and no significant changes occurred in this group's airway reactivity or cells in lavage fluid after bronchial challenge with RWE. In contrast, all sensitized rabbits developed a LAR, and airway reactivity for this group was markedly increased 3 days later. In addition, the total number of cells including both polymorphonuclear and mononuclear cells in lavage fluid increased significantly 3 days after the LAR. Ten days after the LAR in the sensitized group (n = 8), as airway reactivity returned towards baseline, so did the cells in lavage. We conclude that increased airway reactivity to histamine is temporally associated with pulmonary inflammation as defined by cells in lavage after the LAR in this model.

Animals↗
PubMed1985

Magnetic resonance imaging in syringomyelia.

Myelography and myelography assisted with computed tomography have been the most commonly used radiographic methods in the study of syringomyelia. These studies have never been entirely reliable in demonstrating the syrinx cavity and its relationship to other intracranial structures. During the 1st year of operation of the magnetic resonance imaging facility, the syringomyelic cavity was demonstrated in 15 patients who all had typical clinical signs and symptoms associated with syringomyelia. Nine cases were syringomyelia with Chiari malformation. One case showed additional hydrocephalus. Four cases were idiopathic, and 1 case was remotely posttraumatic. Magnetic resonance imaging, although it is in its infancy, already promises to be the most important radiographic technique for syringomyelia because it provides an anatomically truthful visualization of the sagittal plane of the cervical cord and can demonstrate the syrinx cavity and its relationship with the cerebellar tonsils, the 4th ventricle, and other related structures.

Adolescent↗
PubMed1985

Esthesioneuroblastoma: treatment of skull-base recurrence.

Thirty-nine patients with esthesioneuroblastoma are reviewed. The presentation of the tumor, symptomatology, investigation, and treatment are discussed. A recommended treatment regimen is outlined. Histologic typing is valueless in predicting tumor behavior. An illustrative and difficult case of recurrent base of skull esthesioneuroblastoma is presented. The resection performed is described, and the problem of extradural oropharyngeal communication is discussed. The solution was to use a temporalis and galeal frontalis flap. Reconstruction was with an external and intraoral prosthesis. Optimal treatment in a fresh lesion is radical surgery with or without radiation therapy. Esthesioneuroblastoma is a rare and often misdiagnosed malignant tumor of the olfactory epithelium. Originally described by Bergen et al. in 1924 as "esthesioneuroepithelioma olfactif," it was introduced into the North American literature by Schall and Lineback in 1951. Since then, fewer than 200 cases have been collected. The various terms used to describe it--olfactory esthesioneuroblastoma, esthesioneurocytoma, and olfactory neuroblastoma--all denote origin from the neural crest. The sensory nerves of smell are short bundles of fibers that originate in the olfactory bulb and pass through the cribriform plate to the olfactory area of the nasal mucosa. This mucosa is located in the most superior part of both nasal fossae. Thus the usual primary sites of occurrence include the superior nasal cavity or nasal septum, and turbinates, the ethmoid, or the cribriform plate, although an extranasal site of origin has been suggested. Symptoms are usually progressive and range from nasal obstruction or epistaxis to diplopia, ocular pain, and headaches in the more advanced disease state.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1984

Prolonged bleeding time associated with moxalactam administration.

A case of moxalactam-induced coagulopathy is reported. The authors think that this coagulopathy is caused by an effect on platelet aggregation and not by inhibition of vitamin K-dependent clotting factors. It is recommended that bleeding times be routinely checked preoperatively in patients being treated with moxalactam.

Bleeding Time↗
PubMed1984

Booster clips for giant and thick-based aneurysms.

The authors describe their experience using booster clips to secure the closure of primary clips in the repair of giant and other thick-walled aneurysms. These clips were used for 21 aneurysms in 20 patients, comprising 12% of all aneurysms operated on during the 15-month period of the report, but representing about 50% of all giant aneurysms operated on during the same time frame. These clips are designed to encircle the primary clip and have fixation "shoes" to close upon the jaws of the primary clip. All aneurysms were opened for decompression and thrombectomy when necessary following temporary major vessel occlusion before placement of the primary clip. Cerebral blood flow measurements and continuous electroencephalographic monitoring were utilized to predict the brain's tolerance to temporary ligation of the internal carotid artery (ICA) in those cases with a giant aneurysm arising from that vessel. There were no complications attributable to the periods of intracranial or cervical ICA occlusion; these periods varied but did not exceed 8 minutes for the former nor the tolerance period for the latter, which was calculated as from 5 to 30 minutes. It was necessary to reoperate on two patients and reposition clips because of stenoses or occlusions identified on immediate postoperative angiography. Fifteen patients had normal neurological function at the time of discharge. Three patients had minor deficits which did not prevent employment; two of these were related to a preoperative deficit and one was a complication of delayed ischemia. There were two deaths: one from bleeding complications and probable damage to perforating vessels in a patient operated on under profound hypothermia (the only case in the series so managed), and one from respiratory complications in a patient with severe pulmonary problems.

Adult↗
PubMed1983

Anterior cranial fossa tumors.

The anterior cranial fossa may be invaded by malignant or nonmalignant tumors arising in the orbit, orbital contents, nose, nasopharynx, or frontal, ethmoid, or sphenoid sinuses. Skin and maxillary tumors can also spread to the skull base. One must be aware of this and assess the situation with the neurosurgeon, and use coronal and axial CAT scans. The approach is intracranial and extracranial, with total en bloc tumor resection under frozen section control. In nonmalignant tumors immediate reconstruction is performed; in malignant tumors, especially recurrent ones, the reconstruction is delayed twelve to eighteen months to lessen the chances of later recurrences. With this approach, recurrences have been few and survival rates excellent, even in advanced recurrent lesions.

Carcinoma, Squamous Cell↗
PubMed1980

Evaluation of clinical stereoacuity tests.

Sixty children ages two to seven were separated into two age-matched groups of thirty each, one consisting of a group of normal children, and the other a strabismic-anisometropic group. All subjects were examined with four currently available stereoacuity tests, the RDE, Randot, Titmus, and the TNO. Significant differences in performance were found between the two groups. Across all tests there was a 10 to 17% over-referral rate and a 33-37% under-referral rate. Untestability in the normal group ranged from 3.3-6.7% across tests, while in the patient group it ranged from 3.3-20.0%. The under-referral rate is unacceptable and casts doubt on the value of our present stereoacuity tests in screening for subtle defects in binocular function in the young child.

Amblyopia↗
PubMedDate not supplied

Results and prognosis following surgery for malignant tumors of the skull base.

A series of 155 malignant craniofacial tumors referred to a specialized craniofacial center for surgical treatment are presented. One quarter of these were primary and three quarters recurrent. The statistics of long-term follow-up are presented, and it is concluded that this type of surgery for these difficult problems is worthwhile. The increasing experience gained from operating on and following up these patients is presented.

Adolescent↗
PubMedDate not supplied

Treatment of tumors involving the anterior cranial fossa.

The potential for a tumor of the upper face, either malignant or nonmalignant, to involve the anterior cranial base is often not appreciated. This leads to inadequate preoperative investigation and to surgery performed by the head and neck surgeon without the help of the neurosurgeon. In this way, complete tumor resection may be compromised or delayed. Neither of these situations is desirable. If the potential for anterior cranial fossa invasion is recognized, there should be prior consultation with the neurosurgeon and a combined operative procedure. Exposure of these lesions has considerably improved with experience in congenital craniofacial deformities: this will allow en bloc resection of most pathologies. Immediate reconstruction after resection of nonmalignant tumors is advocated, but in aggressive--particularly in recurrent--malignancies, delayed reconstruction is advised. Careful combined follow-up with frequent blind biopsies should be carried out as indicated.

Adult↗
PubMedDate not supplied

Extratemporal cortical resections and lesionectomies for partial epilepsy: complications of surgical treatment.

Fifty patients with medically refractory extratemporal seizures underwent epilepsy surgery at our institution between 1988 and 1992. Twenty-nine patients (group I) had an extratemporal (mainly frontal lobe) corticectomy, and 21 patients (group II) had an epileptogenic lesion extirpated without resection of the epileptic brain tissue. Comprehensive neurologic evaluation was performed preoperatively, soon after operation, and approximately 3 months postoperatively to assess operative outcome. Magnetic resonance imaging (MRI) in group I patients usually showed no abnormality or a large destructive lesion. Neuroimaging showed a foreign tissue lesion in most group II patients. Thirteen of the 29 patients who underwent corticectomy had at least one adverse event (AE) potentially related to operation at the time of initial assessment. Four of the 13 patients required a surgical procedure to treat the operative complication, but only 1 of the 13 patients had a persistent neurologic deficit at follow-up examination. Three of the 21 patients who received lesionectomy had acute and persistent neurologic morbidity. Patients undergoing cortical resection remained intubated longer postoperatively (p < 0.005), and required longer hospitalization after operation (p < 0.001) and in the intensive care unit (p < 0.001) as compared with the lesionectomy group. Results of this study may prove useful in counseling patients regarding neurologic outcome after extratemporal surgery.

Adolescent↗
PubMedDate not supplied

Relief of diabetic neuropathy with fluoxetine.

A 31-year-old woman with advanced diabetes mellitus with secondary autonomic and peripheral neuropathy was admitted for treatment of major depression. Previous therapy with desipramine resulted in exacerbation of the patient's orthostatic hypotension. After admission to the psychiatric facility she was initially stabilized medically and treated with psychotherapy. Subsequent treatment with low-dose fluoxetine 5 mg resulted in a decrease of the patient's diabetic neuropathy pain. Further increases in the fluoxetine dosage resulted in improvement of her depression and increased pain relief. Therapy with fluoxetine did not result in exacerbation of the orthostatic hypotension. This preliminary case report indicates that fluoxetine may be an alternative to the tricyclic antidepressants and trazodone in the treatment of diabetic peripheral neuropathy.

Adult↗
PubMedDate not supplied

Spinal dural arteriovenous fistulas: MR and myelographic findings.

PURPOSE: To examine the clinical and radiographic findings in a large group of patients having or suspected of having a spinal dural arteriovenous fistula. METHODS: An analysis of 240 spinal angiograms in 132 patients revealed 97 vascular malformations that included 66 spinal dural arteriovenous fistulas. Sixteen patients had 1 or more normal spinal angiograms that were performed for suspected spinal dural arteriovenous fistulas on other imaging studies. The imaging and clinical data were reviewed in all patients who had or were suspected of having a spinal dural arteriovenous fistula and who had a spinal MR (n = 44) and a myelogram (n = 37). RESULTS: Spinal dural arteriovenous fistulas were more common in males (3.4:1) with an average age of 62 years (range, 37 to 81 years). The average time from onset of symptoms to diagnosis was 27 months. Clinical findings included weakness (55%), a progressive clinical course (100%), and a myelopathy on exam (84%). The nidus of the fistula was located between T-6 and T-12 in 61%, in the sacrum in 9%, and intracranially in 8%. In the spinal dural arteriovenous fistula group, vessels were seen on supine myelography in all patients. MR findings in this group included increased T2 signal in the cord (100%), gadolinium enhancement (88%), mass effect (45%), and flow voids (T1, 35%; T2, 45%). The patients in the negative spinal angiogram group were younger (average age, 51 years), had symptoms longer (average time from symptom onset to spinal angiogram, 59 months), and presented with numbness or pain (76%). When compared with the patients with spinal dural arteriovenous fistula, acute or stable deficits were more common (31%), and myelopathy on exam was less common (56%). Although the angiogram-negative patients commonly had vessels on the myelogram (92%), abnormal T2 signal in the cord was unusual (17%). CONCLUSIONS: In the appropriate clinical setting, high T2 signal of the spinal cord is the most sensitive imaging finding in spinal dural arteriovenous fistula. The presence of mass effect and enhancement should not discourage this diagnosis. The likelihood of finding a spinal dural arteriovenous fistula in a patient without T2 signal on MR is low.

Adult↗