Benign cystic teratoma in a pre-pubertal girl.
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Abdominal Pain↗
Biomedical subjects
W Reid
Publications and source records attributed to W Reid.
Is magnetic resonance cholangiopancreatography the new gold standard in biliary imaging?
The timing and technique of perioperative biliary imaging in relation to laparoscopic surgery remains controversial. This study assessed the predictive value of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of biliary pathology. Clinical, laboratory and investigational data were evaluated from 374 patients undergoing MRCP at two hospital sites over a 5-year period. MRCP findings were compared with endoscopic retrograde cholangiopancreatography (ERCP) or operative findings and appropriate clinical endpoints. Complete data were available for 351 of the 374 patients (94%), of whom 232 (66%) were female. Median age was 64 years. The predominant presentation was abdominal pain (n = 190). Features of pancreatitis were present in 59, cholangitis in 26 and jaundice in 109 patients. Ultrasound was the initial investigation in 312 (89%) (176-gallstone positive). Common duct dilatation was evident in 114 patients and ductal calculi in 31. ERCP was successful in 212/283 (75%) patients. Significant ERCP induced pancreatitis occurred in 12 (5.6%). Comparison between MRCP and ERCP was not possible in 85 due to failure of either technique. Nine patients underwent other investigations including intraoperative cholangiogram (IOC), percutaneous transhepatic cholangiogram (PTC) and were included. Of the 221 patients with full comparative data available the MRCP showed a sensitivity of 97.98% and specificity of 84.4%. MRCP is highly sensitive and specific for choledocholithiasis and avoids the need for invasive imaging in most patients with suspected choledocholithiasis.
Abdominal Pain↗
Developing and implementing organisational practice that delivers better, safer care.
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European Union↗
Biological activities of an extract from Cleome viscosa L. (Capparaceae).
Electron micrograph examination of the leaf and stem surfaces of Cleome viscosa L (Family Capparaceae) revealed the presence of secretory glandular trichomes with club-cylinder and cylinder morphologies. In the present study, the leaves and stems of C. viscosa were extracted with hexane and the extract was evaluated for the following biological activities: anti-bacterial, anti-fungal, contact insecticidal and nematicidal. The extract was found to be a potent anti-bacterial agent according to the thin layer chromatography autobiographic assay. Activity-directed isolation studies of the anti-bacterially active compounds led to a 14-member ring cembranoid diterpene being identified as one of the effective agents. Minimum inhibitory concentration (MIC) values (microg/spot) of 5.0 microg/spot and 1.0 microg/spot were found for the diterpene on Bacillus subtilis (Gram-positive) and Pseudomonas fluorescens (Gram-negative), respectively. The diterpene did not inhibit the growth of the fungus Cladosporium cucumerinum. The extract demonstrated a pyrethroid type of contact insecticidal activity on adult Cylas formicarius elegantulus Summer (Coleoptera: Curculionidae). The extract also had high nematicidal activity with a percentage Abbott's value of 72.69 on the plant parasitic nematode Meloidogyne incognita Chitwood; however, the extract lost its potency upon subfractionation.
Animals↗
The wart-like chorion of Edessa bifida (Hemiptera: Pentatomidae).
There is the suspicion that the stink bug Edessa bifida invades cotton fields in Southern parts of North America. To assist in the early detection of the bug, the morphology of deposited eggs of E. bifida is described using scanning electron microscopy (SEM). The study revealed a surface pattern not yet seen in the Pentatomidae. The almost spherical eggs are deposited in batches and fastened both to one another and to the plant surface by secretions in all likelihood produced by the female. The egg surface is characterized by pentagons and hexagons formed by slender ridges. The lumen of these polygons shows 1 to 4 circular elevations of variable size and a flat upper face. In contrast to the ridges the elevations are relatively conspicuous. They are reminiscent of tiny warts and therefore the chorion of E. bifida is referred to as 'wart-like chorion'. Twenty-eight to 31 short aero-micropylar processes are mounted in a circumferential row at the anterior pole of the eggs. The discussion focuses on the variability of the chorion in the stink bugs.
Animals↗
Eggs of the stink bug Acrosternum (Chinavia) marginatum (Hemiptera: Pentatomidae): a scanning electron microscopy study.
The morphology of the outer face of the eggshell, its appearance in cross fractures and the surface morphology of the inner face are described in the green stink bug Acrosternum (Chinavia) marginatum (Hemiptera: Pentatomidae) using scanning electron microscopy. Deposited eggs are barrel-shaped and the surface consists of hexagonally arranged, funnel-shaped pits that possess transverse diaphragms in their slender, basal portions. Only minor differences are detectable between the central portion of the anterior plate (the operculum) and the lateral wall together with the basal portion of the eggshell. The rim at the anterior pole of the egg carries processes with a bulbous end, the aero-micropylar processes. A narrow band of the anterior plate bordering these processes shows hexagonally arranged elements. These differ from those of the operculum and the lateral wall, in that cylindrical pits are abundant. During hatching, the operculum is lifted precisely at the rim of this area. Inspection of the periphery of the inner face of the operculum reveals slender, radially arranged grooves. Their arrangement and spacing indicate that they bear a spatial relationship with the aero-micropylar processes. Their role may lie in guiding the sperm to the site where fertilization occurs and in facilitating the gas exchange of the embryo. The remainder of the eggshell carries shallow elevations at its inner face. Exterior and interior features of the eggshell, as well as its appearance in cross-fractures, are discussed.
Animals↗
An HIV-1 transgenic rat that develops HIV-related pathology and immunologic dysfunction.
We report, to our knowledge, the first HIV type 1 (HIV-1) transgenic (Tg) rat. Expression of the transgene, consisting of an HIV-1 provirus with a functional deletion of gag and pol, is regulated by the viral long terminal repeat. Spliced and unspliced viral transcripts were expressed in lymph nodes, thymus, liver, kidney, and spleen, suggesting that Tat and Rev are functional. Viral proteins were identified in spleen tissue sections by immunohistochemistry and gp120 was present in splenic macrophages, T and B cells, and in serum. Clinical signs included wasting, mild to severe skin lesions, opaque cataracts, neurological signs, and respiratory difficulty. Histopathology included a selective loss of splenocytes within the periarterial lymphoid sheath, increased apoptosis of endothelial cells and splenocytes, follicular hyperplasia of the spleen, lymphocyte depletion of mesenteric lymph nodes, interstitial pneumonia, psoriatic skin lesions, and neurological, cardiac, and renal pathologies. Immunologically, delayed-type hypersensitivity response to keyhole limpet hemocyanin was diminished. By contrast, Ab titers and proliferative response to recall antigen (keyhole limpet hemocyanin) were normal. The HIV-1 Tg rat thus has many similarities to humans infected with HIV-1 in expression of viral genes, immune-response alterations, and pathologies resulting from infection. The HIV-1 Tg rat may provide a valuable model for some of the pathogenic manifestations of chronic HIV-1 diseases and could be useful in testing therapeutic regimens targeted to stages of viral replication subsequent to proviral integration.
Animals↗
Internal jugular vein thrombosis following in-vitro fertilization in a woman with protein S deficiency and heterozygosity for the prothrombin 3' UTR mutation, despite anticoagulation with heparin.
We report the case of a 31-year-old woman with protein S deficiency and heterozygosity for the prothrombin 3' UTR mutation who developed an internal jugular vein thrombosis despite therapeutic anticoagulation with a low molecular weight heparin, following in-vitro fertilization. This case indicates that the stimulus to thrombosis in such women is intense and can occur despite apparent therapeutic anticoagulation. Close attention should, therefore, be paid to any women with a personal or family history of thrombosis and the potential thrombotic risks associated with assisted conception must be discussed.
3' Untranslated Regions↗
Cervical abnormality and sexually transmitted disease screening in human immunodeficiency virus-positive women.
OBJECTIVE: To determine the incidence of genital tract infections and cervical abnormalities in 185 human immunodeficiency virus (HIV)-positive outpatients with a view toward establishing an effective policy for gynecology screening. METHODS: Gynecology results were reviewed for 185 HIV-positive women seen as outpatients at the Royal Free Hospital in London. All subjects underwent screening for cervical abnormalities (smear and colposcopy) and sexually transmitted disease (STD) at 6-month intervals for 6 years. The STD prevalence was calculated, and the relationship between the occurrence of STDs and the demography and sexual lifestyle of the women was examined to determine whether these factors were predictive for women at risk for STDs. The incidence of cervical intraepithelial neoplasia (CIN) was determined. We reviewed the use of colposcopy in addition to cytology as a primary screening test to see whether it improved the detection rate of CIN. RESULTS: Sixty-five (35.1%) women had a history of previous STDs, and new STDs were detected in 18 women at their first visits. None were detected at subsequent visits. Sexual lifestyle details did not predict women at risk for STDs. Ninety-eight (53%) cervical smears were reported as normal at the first visit, but there was a 3.1% (95% confidence interval 0, 6.6) false-negative rate when compared with colposcopy and directed biopsy. Five of fifty women (10%) with CIN I had progressed to higher-grade lesions by 6-month follow-up. CONCLUSIONS: Given the low prevalence of STDs detected, except for initial screening at presentation, regular, repeat STD screening of HIV-positive women appears to be unnecessary. Because of the high incidence of cervical abnormalities, screening for cervical biopsy improved the detection rate of cervical abnormalities.
Adult↗
Prospective regional study of planned home births. Home Birth Study Steering Group.
OBJECTIVE: To collect data from a cohort of women requesting a home birth and examine the experience and outcome of pregnancy, the indications for hospital transfer, and the attitudes of mothers, midwives, and general practitioners. DESIGN: Follow up study with anonymised postal questionnaires. SETTING: Northern Regional Health Authority area. SUBJECTS: The 256 women resident in the Northern region who expected to deliver in 1993 and whose request for a home birth became known to one of the local supervisors of midwives. Limited cross validating information was also collected retrospectively on all other women delivering a baby outside hospital in 1993. MAIN OUTCOME MEASURES: Rate of and reason for transferred care; maternal, midwifery, and general practitioner views; perinatal outcome. RESULTS: Five women miscarried, leaving 251 in the study. Of these, 142 (57%) delivered at home. There were 17 (7%) caesarean sections but no perinatal deaths. General practitioners had reservations about half of the booking requests. Two thirds of the women thought they had not been offered any option about place of birth, 74 (29%) were referred to hospital for delivery before the onset of labour, and 35 (14%) were referred to hospital during labour. Intrapartum transfers were uneventful, and half the mothers commented spontaneously that they valued having spent even part of their labour at home. CONCLUSIONS: Home birth is valued for its family setting. General practitioners' support is sought and influential but uncommon, possibly because of a lack of understanding of the responsibilities of the midwife and general practitioner.
Attitude of Health Personnel↗
Neuroleptic prescribing in residents of nursing homes. Behaviour problems are underdocumented.
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Aged↗
Government secrecy. Ombudsman is available when codes of practice fail.
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Government↗
Age at onset and pattern of neuropsychological impairment in mild early-stage Alzheimer disease. A study of a community-based population.
OBJECTIVES: To examine the effects of age at onset on neuropsychological functioning in a group of patients with probable Alzheimer disease (AD) and, within this group, to scrutinize further those patients with mild early-onset disease as it was hypothesized that within this group specific patterns of cognitive impairment could be identified that correlated with neuropathological staging of the disease. DESIGN: Each patient underwent an extensive neuropsychological test battery to examine a wide range of cognitive processes to provide information to identify subtypes of dementia. SETTING: The Memory Clinic in the Department of Geriatric Medicine, Concord Hospital, Concord, New South Wales, Australia. PATIENTS: One hundred forty-five community-residing case patients with probable AD were studied; within this group, 51 case patients with mild AD and a Mini-Mental State Examination score greater than 19 were further examined; 36 similarly aged control patients who were part of a larger case-control study of AD in an urban population were also examined. A diagnosis of probable and possible AD was made if the case patient had evidence of memory impairment and met criteria according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association. OUTCOME MEASURES: Individual neuropsychological test scores were compared. The tests were then grouped into 7 cognitive domains. Patterns of early cognitive impairment were derived from these comparisons. RESULTS: With an earlier age at onset, significantly more impairment on tests of digit span and praxis was seen, while the duration of disease had no independent effect once the age at onset was fixed. Patients with mild early-onset dementia and a Mini-Mental State Examination score greater than 19 showed significant impairment in tests of attention, memory, frontal/executive functions, visuospatial ability, praxis, and visual agnosia compared with that shown by control patients. In this group, further analyses revealed that impairment in memory and frontal/ executive functions were the earliest signs of cognitive impairment. CONCLUSIONS: These data showed that when the duration of disease was adjusted for, case patients with an earlier age at onset of AD demonstrated significantly more impairment on tests of attention span and working memory (digit span), graphomotor function (copy loops), and apraxia than those with an older age at onset. Our findings support the view that the hippocampus and its connections are affected in the early stages of AD. The deficits in the frontal/executive functions also suggest that a disruption of cortical pathways to the frontal lobes and the pathological changes in this region occur early in the disease.
Age of Onset↗
Infertility among human immunodeficiency virus-positive women: incidence and treatment dilemmas.
The increasing demand for fertility advice among human immunodeficiency virus (HIV)-positive women under our care led us to review the incidence of infertility and the ethical problems associated with its management. All HIV-positive women who attended the HIV outpatients clinic from October 1990 to the end of January 1996 were studied. The main outcome measures were: the number of women undergoing infertility investigations before and after HIV diagnosis, their demographic and social details, and the outcome of these investigations. Most of the 183 women studied were in their reproductive years (mean age 32.7 +/- 6.7 years). Nine women had undergone infertility investigations, and/or treatment before HIV diagnosis, three of whom were diagnosed with HIV during routine testing prior to IVF treatment. Six declined further infertility treatment after discovering their HIV status. Eight women have undergone infertility investigations after HIV diagnosis but none have achieved pregnancy to date. Management decisions may have been hampered by ethical uncertainties in several cases. In conclusion therefore, as requests for infertility treatment from HIV-infected women occur and may become more common as the prevalence of HIV infection in women continues to rise, the ethical issues associated with the management of this problem demand urgent attention so that clear guidelines are available to aid treatment decisions.
Acquired Immunodeficiency Syndrome↗
An exploration of nurses' attitudes to the nursing care of the suicidal patient in an acute psychiatric ward.
Suicidal patients admitted to hospital following a suicidal attempt or expressing suicidal ideation present a real challenge to health professionals with regard to their therapeutic care. This study was undertaken to explore the attitudes of psychiatric nurses caring for such patients. Results reveal that psychiatric nurses do hold positive views on caring for potentially suicidal patients, contradicting previous studies where more negative feeling were expressed by nurses, especially those with initial contact. Findings also show that some nurses experience an element of distress, and the length of experience within such a working environment does not affect the nurses' level of satisfaction gained on caring for the suicidal patient. This study also identifies an expression of need for further education and practice in interpersonal skills and therapeutic modalities to enhance and develop a more effective delivery of care for this group of patients.
Adolescent↗
Thyroid cancer in the United States since accident at Chernobyl.
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Adolescent↗
Ectopic expression of gamma interferon in the eyes of transgenic mice induces ocular pathology and MHC class II gene expression.
PURPOSE: To direct the expression of gamma IFN to the eyes of transgenic mice as a means of investigating the possible role of this lymphokine in ocular pathogenesis. METHODS: Transgenic mouse strains were generated by injection of a DNA fragment containing the murine alpha A-crystallin promoter fused to the coding sequence of murine gamma IFN gene. PCR and RT-PCR were used to screen for the presence of the transgene and mRNA analyses, respectively. Methacrylate-embedded eye sections were analyzed for morphology and cryosections for immunoperoxidase antibody staining. RESULTS: The most notable effects of gamma IFN in these transgenic mice include cataract, microphthalmia, blepharophimosis, microphakia, impairment of lens fiber formation, arrest of retinal differentiation, serous retinal detachment with presence of macrophages in the subretinal space, persistent hyperplastic primary vitreous, and corneal vascularization. MHC class II mRNA levels were significantly increased in the transgenic eyes and MHC class II proteins were expressed in their cornea, iris, ciliary body, choroid, lens and RPE. CONCLUSIONS: Ectopic expression of gamma IFN in the lens affected the growth of the whole eye, resulting in microphthalmia and microphakia. The author's data suggest that alpha ACry-gamma IFN transgenic mouse ocular cells express functional gamma IFN receptors and that interaction of gamma IFN with its receptor induced biochemical and morphologic changes in the transgenic eyes. These mice provide an animal model for the study of the linkage between aberrant MHC expression and predisposition to autoimmune diseases.
Animals↗