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PubMed2004

Thyroid colloid nodules diagnosed by fine-needle aspiration: efficacy of suppression.

BACKGROUND: This study reviewed the accuracy of fine-needle aspiration biopsy (FNAB) and the efficacy of thyroid suppression for colloid nodules in our population to determine the utility of these two modalities on the decision to operate. METHODS AND MATERIALS: A retrospective chart review of patients with colloid nodules diagnosed by FNAB from January 1993 to July 1995 was conducted. A 52-patient cohort underwent surgical management, and their needle aspirate cytologies and final pathologies were reviewed. RESULTS: A 7.7% false-negative rate in the detection of thyroid malignancy by FNAB was obtained. This is in keeping with data reported in the literature. Virtually no efficacy of hormonal suppression in our population was found. CONCLUSION: When the literature is reviewed and compared with the results of this study, the use of FNAB as a decision tool to operate is valid. The decision to operate based on the outcome of hormonal suppression, however, is not valid based on our results.

Biopsy, Needle↗
PubMed1998

Reduced mortality in association with the acute respiratory distress syndrome (ARDS).

BACKGROUND: A study was undertaken to investigate possible reductions in mortality and/or changes in outcome predictive factors in patients with the acute respiratory distress syndrome (ARDS) managed in a single centre. METHODS: The study was a prospective observational cohort study of two patient populations with ARDS. Group 1 comprised 41 patients enrolled between May 1990 and April 1993, and group 2 consisted of 78 patients enrolled between June 1993 and March 1997. The end points of the study were mortality and various factors predictive of death. RESULTS: There was a marked reduction in mortality between groups 1 and 2 (66% versus 34%; relative risk 1.77; CI 1.23 to 2.55). There were no significant differences between the groups in terms of age (40.6 (3.3) versus 45.5 (2.2) years), APACHE score (14.5 (0.72) versus 13.6 (0.1)), lung injury score (2.95 (0.07) versus 2.8 (0.1)), incidence of multi-organ failure (29% versus 32%), incidence of sepsis (31% versus 39%), or PaO2/FIO2 (kPa) ratio (11.8 (0.67) versus 12.0 (0.6)). There was a significantly lower proportion of men in group 1 (51% versus 74%). The case mix of the two groups was closely matched: following elective surgery 48% versus 48%, trauma 17% versus 16%, primary lung injury 12% versus 24%. Patients in group 1 were supported using several ventilatory and other modes (volume preset, non-inverse ratio ventilation, n = 15; pressure controlled inverse ratio ventilation (PC-IRV), n = 11; ultra high frequency jet ventilation (UHFJV), n = 13; an intravascular oxygenation device (IVOX) and extracorporeal gas exchange (ECGE), n = 2). Within group 1 no significant difference in mortality was observed between the patients on volume controlled ventilation and the remainder. In group 2 all patients received PC-IRV (n = 78) but, in addition, some received other support techniques (UHFJV n = 4, ECGE n = 2). In group 1 only sepsis on admission (21% (survivors) versus 56% (non-survivors)) predicted death. In group 2 age of survivors and non-survivors (41.2 (2.6) versus 52.6 (3.5)), APACHE score (12.2 (0.6) versus 15.8 (0.9)), and PaO2/FIO2 (12.8 (0.86) versus 10.5 (0.72)) predicted survival, but not the incidence of sepsis or multi-organ failure. CONCLUSIONS: In recent years a highly significant reduction in mortality associated with ARDS has been observed between two groups of patients well matched for disease severity and case mix. Changes in ICU organisation rather than specific interventions may account for this reduction, although different ventilatory and other management strategies used in the two groups may also be relevant.

Adult↗
PubMed2002

Porphyria cutanea tarda presenting as cicatricial conjunctivitis.

PURPOSE: To report a case of porphyria cutanea tarda presenting as cicatricial conjunctivitis. DESIGN: Observational study. METHODS: A 31-year-old man presented with bilateral inferior symblepharon, superior tarsal conjunctival scarring and concretions, and recurrent conjunctival and episcleral injection. RESULTS: Four years after initial presentation, the patient developed hepatitis C, and 2 years later blisters on his scalp and hands. Direct immunofluorescence studies of biopsies taken from the palpebral conjunctiva of the right lower lid were negative for cicatricial pemphigoid. A twenty-four hour urine specimen analysis revealed elevated levels of uroporphyrins and polycarboxylated porphyrins, confirming the diagnosis of porphyria cutanea tarda. The patient was treated with repeated phlebotomies and oral hydroxychloroquine, which resulted in a significant decrease in the skin lesions, conjunctival injection, and concretions under the upper lids. CONCLUSIONS: Cicatricial conjunctivitis may be a manifestation of porphyria cutanea tarda.

Administration, Oral↗
PubMed2005

Reducing risk in infant cardiopulmonary bypass: the use of a miniaturized circuit and a crystalloid prime improves cardiopulmonary function and increases cerebral blood flow.

Advances in perfusion strategies have played an important role in improving outcomes following repair of complex congenital heart defects. The influence of cooling strategy, temperature, duration of circulatory arrest, and specific method of cerebral perfusion on neurologic morbidity have been extensively characterized. Similarly, the ability of pharmacologic agents to modulate the post-cardiopulmonary bypass (CPB) inflammatory response has been previously elucidated in both the laboratory and clinical arena. However, modification of the circuit and priming components have received comparably less attention. We recently showed that employment of a miniaturized circuit and a bloodless prime reduce inflammation and have salutary effects on cardiopulmonary function following hypothermic low-flow perfusion (HLF), and that this circuit may also improve cerebral protection following both deep hypothermic circulatory arrest and HLF. The current report, therefore, reviews current strategies utilized to minimize post-CPB inflammation and highlights the empirical evidence from our laboratory demonstrating the beneficial role of a miniaturized extracorporeal circuit in this context.

Animals↗
PubMed1990

A randomized comparison of manipulation of the fractured nose under local and general anaesthesia.

Reduction of simple nasal fractures may be performed under local or general anaesthesia: the latter is by far the most popular method in Britain, though why is hard to define. We have attempted to compare the 2 approaches by means of a randomized, prospective trial. Fifty consecutive, adult patients with radiologically proved fractures of the nasal bones were randomized to a local or general anaesthesia group and underwent manipulation with Asch's and Walsham's forceps between 7 and 15 days post-injury. Analysis of results at 4 h and 8 weeks post-operatively showed no significant benefit conferred by fracture reduction under general anaesthesia as opposed to local anaesthesia with respect to post-operative airway patency or cosmesis. It is suggested that significant benefits can be obtained in terms of patient convenience and cost effectiveness if nasal fractures are reduced under local anaesthesia as an outpatient procedure.

Adult↗
PubMed1991

Differential Distribution of Somatostatin-like Immunoreactivity in the Visual Sector of the Thalamic Reticular Nucleus in Galago.

Immunocytochemical methods were used to compare the distributions of somatostatin-14 (SOM) and glutamic acid decarboxylase (GAD) in the medial and lateral tiers of the visual sector of the thalamic reticular nucleus in the bushbaby, Galago. As expected, all of the neurons in the visual sector were immunoreactive for GAD, the synthesizing enzyme for GABA, but the distribution of SOM-immunoreactive cells was not uniform. It appeared that every cell in the medial tier was immunoreactive for SOM, but that very few cells in the lateral tier contained this neuropeptide. The significance of the difference in reticular neuron SOM content could be related to the functional differences between the dorsal lateral geniculate nucleus, which is connected reciprocally with the lateral tier, and the pulvinar nucleus, which is connected reciprocally with the medial tier.

Journal Article↗
PubMed1995

Cochlear implants in chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) in profoundly deaf patients is a contraindication for cochlear implantation. Eight (6%) of the 126 patients referred to cochlear implantation at this center between 1986 and 1992 became deafened as a result of bilateral CSOM but were otherwise suitable candidates. This study details the methods used in four patients to prepare the septic ear for a sterile device. Two patients had wet radical cavities with residual cholesteatoma, and two had discharging safe perforations resistant to surgical repair. Obliteration of the middle ear cleft with blind pit closure of the ear canal was attempted in all four patients, and cochlear implants were installed at a second operation 3 to 6 months later. The hearing results were as good as in implanted patients without CSOM, and the only complication has been the finding of a cholesteatoma pearl at the second operation in one patient. Fat obliteration of the mastoid and middle ear with blind pit closure of the ear canal can be adapted to make most chronic ears fit for implantation, if the patient is prepared to undergo two operations.

Aged↗
PubMedDate not supplied

Opiate and sedative dependence predicts a poor outcome for patients receiving home parenteral nutrition.

BACKGROUND: Home parenteral nutrition (HPN) is used to treat intestinal failure. A minority of HPN patients are dependent on opiates and benzodiazepines to control pain and anxiety. The aim of this study was to determine what effects such drug dependence had on patient outcomes. METHODS: Ten dependent patients were prospectively compared with 10 well-matched, nondependent HPN patients for the same 12-month period. Episodes of line sepsis and other complications were documented and the cost of treatment estimated. Health status was measured using the SF36 and EuroQol instruments. RESULTS: The dependent group had significantly more episodes of central line sepsis (p = .0007) as well as other complications (p = .0002). This led to significantly longer periods of inpatient care (p = .0004) and therefore higher costs of treatment. Health status was lower in the dependent group; they reported more pain (p = .04) and less energy (p = .04). CONCLUSIONS: The complication rate and increased cost of treatment for opiate- and sedative-dependent patients receiving HPN significantly detract from the overall outcome of this therapy.

Adult↗
PubMed2003

Peripheral hypertrophic subepithelial corneal degeneration.

PURPOSE: To describe the clinical features, clinical course, and response to therapy of an atypical peripheral corneal opacification. METHODS: Retrospective case series review. RESULTS: Six patients are described with similar findings of bilateral, fairly symmetric, peripheral, hypertrophic, subepithelial corneal opacification. All patients were female and had no concurrent systemic conditions. All six patients complained of ocular irritation. Three patients complained of blurred vision, and one patient had monocular diplopia. In three patients followed up for more than 30 months, the corneal opacification remained stable in one patient and enlarged in the other two patients. The other three patients were examined once or twice, so the evaluation of disease progression was precluded. Two patients were treated surgically with superficial keratectomy followed by 2-minute intraoperative application of 0.02% mitomycin-C. Pathologic examination of bilateral keratectomy specimens from one patient showed subepithelial fibrosis without inflammation. CONCLUSIONS: The clinical findings are reminiscent but atypical of Salzmann nodular degeneration.

Adult↗
PubMed1996

The presence of rheumatoid factor in sera from anti-HCV positive blood donors interferes with the detection of HCV-specific IgM. Trent HCV Study Group.

BACKGROUND/AIMS: IgM anti-HCV has been reported as a useful marker of disease activity and of likely response to interferon therapy in patients with chronic hepatitis C virus infection. Sera from patients with hepatitis C virus infection may contain rheumatoid factor. This study was designed to investigate the possible effect of rheumatoid factor in an IgM anti-HCV assay. METHODS: Sera from 75 blood donors with chronic hepatitis C virus infection were tested for the presence of IgM anti-HCV using a core-derived peptide as antigen, before and after removal of IgG. These sera and appropriate control sera were also tested for the presence of rheumatoid factor. RESULTS: Removal of IgG prior to IgM testing resulted in a significant loss of reactivity in the IgM anti-HCV assay in 30/41 sera that were positive in this assay when tested untreated. Seventy per cent of anti-HCV positive sera were also positive for rheumatoid factor. CONCLUSIONS: Rheumatoid factor causes significant false positive reactivity in IgM anti-HCV detection assays. The results of assays that do not account for this interference should be viewed with caution.

Antibody Specificity↗
PubMed1998

Psychological factors associated with recurrent vaginal candidiasis: a preliminary study.

OBJECTIVE: To identify psychological factors associated with chronic recurrent vaginal candidiasis. DESIGN: A cross sectional exploratory study of women with chronic, recurrent vaginal candidiasis. PATIENTS: 28 women found culture positive and treated for vaginal candidiasis by a clinic physician at least twice within the past 6 months. All women reported that they had experienced vaginal thrush six or more times within 1 year. A comparison group comprised 16 women with no history of recurrent vaginal candidiasis, of similar age range, and recruited from a women's family planning service. METHODS: Both groups were compared on demographic criteria, sexual health histories, mental health, and psychological health characteristics. A purpose designed structured interview was administered alongside a battery of standardised psychometric instruments measuring mood, satisfaction with life, self esteem, and perceived stress. RESULTS: The two groups showed considerable similarities, with no significant differences in demographic characteristics and most sexual health issues. However, women with recurrent vaginal candidiasis were significantly more likely to suffer clinical depression, to be less satisfied with life, to have poorer self esteem, and to perceive their lives as more stressful. Additionally, women with recurrent vaginal candidiasis reported that their candidiasis seriously interfered with their sexual and emotional relationships. CONCLUSIONS: Overall, this study identified many areas of psychological morbidity associated with chronic vaginal candidiasis, and indicates that development of appropriate psychological treatment initiatives in this area is long overdue.

Adult↗
PubMed2025

Germline stem cell isolation, lineage tracing, and aging in a protochordate.

Germline stem cells (GSCs), the source of gametes, are the only stem cells capable of passing genes to future generations and are therefore considered units of natural selection. Yet, the factors that influence GSC fitness, and thus govern GSC competition, which exist in both protochordates and mammals, remain poorly understood. We studied how aging affects GSC fitness in the protochordate Botryllus schlosseri, an evolutionary crosspoint between invertebrates and vertebrates. GSCs were isolated and distinguished from developing and mature gametes using flow cytometry and scRNA-Seq, facilitated by a new PacBio genome assembly. Moreover, their function was validated through a novel lineage tracing approach that combines membrane-labeled GSC transplantation with scRNA-Seq. Leveraging our method to isolate them, single-cell transcriptomics showed significant age-related changes between young and old GSCs. Spermatids and sperm, however, showed minimal changes, suggesting that reproductive aging is governed by GSCs rather than by gametes. Reduced expressions of markers like DDX4 and PIWIL1 in aged GSCs mirrored trends in mammalian datasets, pointing to a conserved GSC-driven aging mechanism across chordate evolution. This study provides new techniques that lay the foundation to investigate further drivers of GSC fitness and highlights fertility-related genes as promising targets for therapies to preserve reproductive health.

Journal Article↗
PubMedDate not supplied

Trends in vigorous physical activity participation among Ontario adolescents, 1997-2001.

OBJECTIVE: This paper examines trends in vigorous physical activity participation among students enrolled in grades 7, 9, 11 and 13 in Ontario between 1997 and 2001. Patterns in participation by gender and grade level are also described. METHODS: Data were derived from the Ontario Student Drug Use Survey for 1997, 1999, and 2001. Three outcomes of vigorous physical activity were included in self-report questionnaires completed by more than 5,000 students over a three-year period. They responded to the survey in classroom groups during school time. Estimates were weighted and variance and statistical tests have been corrected for the complex sample design. RESULTS: Comparisons between 1997 and 2001 indicated that, overall, patterns of vigorous physical activity remained stable. However, there were significant declines in vigorous physical activity participation by females and 11th grade students between 1997 and 2001. INTERPRETATION: The trends for females and 11th graders are disturbing, since they indicate that the normal gender and age differences in vigorous physical activity participation, found in numerous previous studies, are compounded by declining levels over time for these groups.

Adolescent↗
PubMed1999

Wood's lamp utility in the identification of semen.

BACKGROUND: The accurate detection of semen is critical to forensic, medical, and legal personnel. The Wood's lamp (WL) emits ultraviolet light (UVL) and has been identified as useful in rape evaluations because it is purported to cause semen to fluoresce. This study was intended to determine if semen can be distinguished from other products by WL analysis. METHODS: Investigators reviewed the previous training and frequency of use of the WL by emergency medicine and pediatric emergency medicine physicians at 2 medical centers. The participants were asked to use a WL to distinguish between a semen sample (<6 hours old) and 13 commonly used products. Next, 29 semen samples were collected and evaluated under high-power microscopy and under UVL. RESULTS: A total of 41 physicians participated in the study (68% male). The number of years practicing in an emergency setting spanned from.3 to 25 years with a mean of 7. 1 years. A total of 51% of participants trained in emergency medicine, 23% in pediatrics and pediatric emergency medicine. A total of 22% reported formal training in the collection of forensic evidence. A total of 62% of the physicians believed they have identified semen in the past; one third felt they could differentiate semen from other products under UVL. None of the 41 physicians were able to differentiate semen from other products using a WL. Moreover, the semen samples used for the study did not fluoresce under WL analysis. None of the 29 semen samples fluoresced whether wet or dry. The medicaments most commonly mistaken for semen were A&D ointment (Cardinal Health, Inc, Dublin, OH), Surgilube (Division of Atlanta, Inc, Melville, NY), Barrier cream (Carrington Laboratories, Inc, Irving, TX), and bacitracin (Division of Atlanta, Inc, Melville, NY). CONCLUSIONS: Participating physicians were unable to distinguish between semen and other common products, using the WL. Although the WL has been purported to be a useful tool as a screening device for the detection of seminal stains, the investigators have found it to be unreliable. Semen, previously reported to fluoresce under WL analysis, does not appear to do so. The correct identification of semen may be complicated by the presence of previously existing ointments and creams, some of which may be iatrogenically introduced (ie, Surgilube).

Adult↗
PubMedDate not supplied

Quality control in combinatorial chemistry: determination of the quantity, purity, and quantitative purity of compounds in combinatorial libraries.

The quality of combinatorial libraries determines the success of biological screening in drug discovery programs. In this paper, we evaluate and compare various methods for measuring identity, purity, and quantity (yield) of combinatorial libraries. Determination of quantitative purity reveals the true library quality and often indicates potential quality problems before full-scale library production. The relative purity can be determined for every member in a large library in a high-throughput mode, but must be cautiously interpreted. In particular, many impurities are not observable by relative purity measurements using detectors such as UV(214), UV(254), and evaporative light-scattering detection. These "invisible" impurities may constitute a significant portion of the sample weight. We found that TFA, plastic extracts, inorganic compounds, and resin washout are among these impurities. With compelling evidence, we reach a conclusion that purification is the only way to remove "invisible" impurities and improve the quantitative purity of any compound even though some compounds may have a high relative purity before purification.

Combinatorial Chemistry Techniques↗
PubMed2001

Airway pressure release ventilation increases cardiac performance in patients with acute lung injury/adult respiratory distress syndrome.

BACKGROUND: The purpose of the present study is to determine whether airway pressure release ventilation (APRV) can safely enhance hemodynamics in patients with acute lung injury (ALI) and/or adult respiratory distress syndrome (ARDS), relative to pressure control ventilation (PCV). METHODS: Patients with severe acute lung injury or ARDS who were managed with inverse-ratio pressure control ventilation, neuromuscular blockade and a pulmonary artery catheter were switched to APRV. Hemodynamic performance, as well as pressor and sedative needs, was assessed after discontinuing neuromuscular blockade RESULTS: Mean age was 58 +/- 9 years (n = 12) and mean Lung Injury Score was 7.6 +/- 2.1. Temperature and arterial oxygen tension/fractional inspired oxygen (FiO2) were similar among the patients. Peak airway pressures fell from 38 +/- 3 for PCV to 25 +/- 3 cmH2O for APRV, and mean pressures fell from 18 +/- 3 for PCV to 12 +/- 2 cmH2O for APRV. Paralytic use and sedative use were significantly lower with APRV than with PCV. Pressor use decreased substantially with ARPV. Lactate levels remained normal, but decreased on APRV. Cardiac index rose from 3.2 +/- 0.4 for PCV to 4.6 +/- 0.3 l/min per m2 body surface area (BSA) for APRV, whereas oxygen delivery increased from 997 +/- 108 for PCV to 1409 +/- 146 ml/min for APRV, and central venous pressure declined from 18 +/- 4 for PCV to 12 +/- 4 cmH2O for APRV. Urine output increased from 0.83 +/- 0.1 for PCV to 0.96 +/- 0.12 ml/kg per hour for APRV. CONCLUSION: APRV may be used safely in patients with ALI/ARDS, and decreases the need for paralysis and sedation as compared with PCV-inverse ratio ventilation (IRV). APRV increases cardiac performance, with decreased pressor use and decreased airway pressure, in patients with ALI/ARDS.

Adult↗
PubMed1997

Assessing the quality of life of patients with intestinal failure on home parenteral nutrition.

BACKGROUND: A study was performed to measure the quality of life of patients receiving home parenteral nutrition (HPN). Quality of life is an important determinant of the effectiveness of health technologies, but it has rarely been assessed in patients receiving HPN. AIMS: To measure quality of life and highlight any moderating factors. PATIENTS AND METHODS: Quality of life was measured using two validated instruments (SF 36 and EuroQol) in 51 patients with intestinal failure. All patients had benign disease, the commonest being Crohn's disease (n = 35). RESULTS: HPN patient scores were worse for six of eight SF 36 domains (p < 0.05) compared with standard population scores. Younger patients (< 45) had good scores but older patients (> 55 years) scored significantly less. Patients addicted to narcotic substances had very low scores. EuroQol utility scores confirmed the SF results. Forty one patients reported that they felt too ill to work and only five were in full time work or education. CONCLUSIONS: The health status profile of our young patients on HPN was good compared with the normal population. The poorest scores were in older patients and those dependent on narcotic drugs. This has clinical and economic relevance when considering such patients for HPN.

Adolescent↗
PubMed2003

Self-collected versus provider-collected vaginal swabs for the diagnosis of bacterial vaginosis: an assessment of validity and reliability.

Bacterial vaginosis (BV) in pregnancy is related to numerous adverse events; however, the validity of different methods of vaginal swab collection to diagnosis BV among pregnant women is unclear. This study examines the validity of self-collected compared with provider-collected vaginal swabs and describes the intra-rater and inter-rater reliability of BV assessment among a sample of pregnant women early in gestation. Gram-stain evaluation of vaginal samples using the Nugent criteria was conducted to determine the overall and morphotype-specific BV scores. We found strong validity for the overall and morphotype-specific scores comparing self-collected swabs to provider-collected swabs. In addition, we found excellent overall and morphotype-specific inter-rater reliability and excellent intra-rater reliability in our sample. These study results support the use of self-collected vaginal swabs for diagnosing BV and document the reliability of BV assessment among pregnant women.

Adult↗