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At least 1,423 records · Page 79Linked to original sources
PubMed2002

Eosinophilic gastroenteritis masquerading as ampullary adenoma.

Eosinophilic gastroenteritis is a rare gastrointestinal disorder of undetermined etiology that is characterized by eosinophilic infiltration of the gut wall. The presenting symptoms depend on the site and depth of intestinal involvement and varies from nausea, vomiting, and abdominal pain to acute bowel obstruction. Pancreaticobiliary obstruction caused by eosinophilic gastroenteritis is rare. We report a 39-year-old man who presented with abdominal pain, vomiting, abnormal liver tests, and a duodenal mass on upper endoscopy. Blood tests showed peripheral eosinophilia. Abdominal computed tomography scan showed a suspected mass in ampullary region. At endoscopic retrograde cholangiopancreatography, both pancreatic and common bile duct were dilated with no obvious ductal strictures. Biopsies from the duodenal mass showed evidence of eosinophilic gastroenteritis. He was successfully treated with prednisone, and his liver test results returned to normal. In conclusion, this unusual case of eosinophilic gastroenteritis presented with duodenal mass that was masquerading as an ampullary adenoma causing pancreaticobiliary obstruction.

Adenoma↗
PubMed1999

Humanizing voice mail in healthcare.

Over the past few years, voice mail has spread rapidly through the corporate environment. Healthcare facilities were slow to adopt this form of telecommunication until it became clear that healthcare was indeed a business, and this innovative technology was becoming a permanent fixture in the business world. Unfortunately, basic two-way communication with compassion, which is so critical to the success of healthcare, became peripheral to computer-mediated technology. While there is debate over the voice mail appropriateness in healthcare, one point of agreement is that voice mail is here to stay. The author examines one hospital's experience with computer-mediated communication, its initiative for improvement without monetary options, and its evolution toward a more compassionate, humanistic system for its internal and external customers.

Computer Communication Networks↗
PubMed2006

Close association between activated platelets and neutrophils in the active phase of ulcerative colitis in humans.

BACKGROUND: Neutrophils are considered to play a causative role in inflammatory mucosal injury in ulcerative colitis (UC), and an association between platelets and neutrophils may contribute to the progression of the inflammatory processes. To test this hypothesis, we performed immunohistochemical and flow cytometric analyses on tissue and blood samples from patients with UC. MATERIALS AND METHODS: Colonic mucosal tissues of patients with active (n = 27) or inactive (n = 16) UC and normal controls (n = 11) were subjected to immunohistochemical staining for markers of activated platelets (glycoprotein IIb/IIIa and P-selectin) and neutrophils (neutrophil elastase, myeloperoxidase, and CD66b). The amounts of stained cells were evaluated by computer-aided morphometry. Peripheral blood samples from patients (n = 8) and healthy volunteers (n = 8) were subjected to comparative flow cytometric analysis of activated platelets. RESULTS: P-selectin-positive activated platelets were frequently aggregated in the inflamed mucosa, especially in ulcerative lesions, and were close to regions of dense neutrophil infiltration. An increase in the number of activated platelets in the colonic lesions was associated with an increase in infiltrating neutrophils and was related to the severity of the disease. The flow cytometric analysis indicated that circulating platelets of patients with UC were highly activated. CONCLUSIONS: The present study demonstrated that a close association between activated platelets and neutrophils is a prominent pathological change in both the affected colonic mucosa and peripheral blood of patients with active-phase UC. This suggests that platelet-neutrophil association may play an important role in the progression of inflammatory processes in UC.

Adult↗
PubMed2003

Partial anomalous pulmonary vein drainage of the left lower lobe: incidental diagnostic after central venous cannulation.

OBJECTIVE: To report a case of partial anomalous pulmonary vein drainage of the left lower lobe diagnosed after central venous cannulation. DESIGN: Retrospective case review. SETTING: Intensive care unit. PATIENT: A 76-yr-old woman with obstructive acute renal failure requiring hemodialysis. INTERVENTIONS: Central venous cannulation and hemodialysis. MEASUREMENTS AND MAIN RESULTS: The diagnosis was suggested by chest radiography after placement of a central venous catheter through the left internal jugular vein. Pressure measurements at the tip of the catheter showed a venous waveform. Oxygen blood content on samples of blood was higher than on peripheral arterial blood. Computed tomography with intravenous contrast was not conclusive. Diagnosis was confirmed with transcatheter phlebography. CONCLUSIONS: It is important for the intensivist to be aware of this infrequent variant when a central venous catheter takes an abnormal route and drains low-pressure, arterialized blood.

Aged↗
PubMed1988

Contrast medium-induced adverse reactions: economic outcome.

Because the cost of managing an expected greater number of adverse reactions when high-osmolality contrast media (HOM) are used could offset the higher material cost of low-osmolality contrast media (LOM), a prospective study was done of 795 inpatients undergoing any of four procedures involving intravascular injection of HOM: cardiac catheterization, peripheral angiography, head computed tomography (CT), or body CT. The resources used in managing HOM-induced adverse reactions were measured, and the costs of these resources were estimated. Four hundred five patients (51%) had adverse reactions. Reactions were grouped into three classes according to their severity. Class 1 (mild) reactions occurred in 358 patients (45%), class 2 (moderate) reactions occurred in 44 patients (6%), and class 3 (severe) reactions occurred in three patients (0.4%). Ninety-nine patients (12%) consumed resources as a result of an adverse reaction. The average cost of these resources per patient undergoing examination was $1.07 to the radiology department, $5.83 to the hospital, and $12.93 to a charge-paying insurer. Mean (+/- standard deviation) cost to the hospital for managing class 1, class 2, and class 3 reactions were $2.52 +/- $5.33, $24 +/- $54, and $910 +/- $749, respectively. By comparison, the difference in material cost of HOM versus LOM ranged from $93 for body CT to $179 for cardiac catheterization. Even if LOM were to induce no adverse reactions, the increased material cost associated with universal substitution of LOM for HOM would be greater than the expected cost of managing adverse reactions when HOM are used.

Adult↗
PubMed1994

Anatomy of membranous bronchioles in normal, senile and emphysematous human lungs.

Serial reconstructions of the membranous bronchioles (MB) were performed in randomly selected tissue blocks cut parallel to the pleural surface in fixated human lungs. Two to four normal, senile, and emphysematous lungs were examined. Three (2 in senile lungs) orders of MB were observed with a dichotomous branching pattern. Emphysematous lungs are characterized by an overall decrease in airway diameter with localized stenoses. Comparison with mean airway diameter (d) and density [n (no. of MBs per cm2 of lung tissue)] of MBs obtained using standard morphometric techniques (random sections approximately 1 cm from the pleura) showed that the values of d and n are biased because of the inclusion in the measurements of a number of respiratory bronchioles and bronchi. When these misclassifications are corrected for, it appears that d corresponds quite well to the mean diameter of the terminal bronchioles (TB) and n to approximately twice the density of TBs. After correction, n is not significantly reduced in emphysematous lungs (the grossly destroyed areas being excluded) compared with normal lungs. The estimate of the number of TBs obtained from the present data is markedly less than that calculated by Weibel (Morphometry of the Human Lung. Berlin: Springer-Verlag, 1963), which suggests that the number of bronchi was overestimated by Weibel by at least one generation. Finally, values of peripheral airway resistance computed from the present anatomic data correspond quite well to direct measurement performed on the same lungs before fixation (Verbeken et al., J. Appl. Physiol. 72:2343-2353, 1992).

Adult↗
PubMed2006

Eosinophilic pancreatitis mimicking pancreatic neoplasia.

Eosinophilic pancreatitis (EP) is a rare disease. It typically occurs in the setting of either eosinophilic gastroenteritis or the hypereosinophilic syndrome. Isolated eosinophilic infiltration of the pancreas is less common. EP usually presents as a pancreatic tumour with abdominal pain and/or obstructive jaundice. The diagnosis is often not made until after pancreatic resection under suspicion of a pancreatic tumour. The case of a 14-year-old boy whose initial presentation was suggestive of a pancreatic tumour is reported. Radiological evaluation revealed a pancreatic mass suggestive of a pancreatic tumour obstructing the duodenum and common bile duct. The patient underwent surgery and a gastrojejunal anostomosis, tube cholecystostomy and biopsy were performed with no postoperative complications. The diagnosis of EP was established after surgical biopsy. The biopsy specimen revealed prominent eosinophilic infiltration. Serum immunoglobulin E levels were elevated. The patient was treated with oral prednisolone (40 mg/day). After two months of oral steroid therapy, clinical manifestations rapidly improved and peripheral eosinophilia subsided. Computed tomography scan revealed remission of the pancreatic mass-like lesion.

Administration, Oral↗
PubMed2004

Considerations for the future development of virtual technology as a rehabilitation tool.

BACKGROUND: Virtual environments (VE) are a powerful tool for various forms of rehabilitation. Coupling VE with high-speed networking [Tele-Immersion] that approaches speeds of 100 Gb/sec can greatly expand its influence in rehabilitation. Accordingly, these new networks will permit various peripherals attached to computers on this network to be connected and to act as fast as if connected to a local PC. This innovation may soon allow the development of previously unheard of networked rehabilitation systems. Rapid advances in this technology need to be coupled with an understanding of how human behavior is affected when immersed in the VE. METHODS: This paper will discuss various forms of VE that are currently available for rehabilitation. The characteristic of these new networks and examine how such networks might be used for extending the rehabilitation clinic to remote areas will be explained. In addition, we will present data from an immersive dynamic virtual environment united with motion of a posture platform to record biomechanical and physiological responses to combined visual, vestibular, and proprioceptive inputs. A 6 degree-of-freedom force plate provides measurements of moments exerted on the base of support. Kinematic data from the head, trunk, and lower limb was collected using 3-D video motion analysis. RESULTS: Our data suggest that when there is a confluence of meaningful inputs, neither vision, vestibular, or proprioceptive inputs are suppressed in healthy adults; the postural response is modulated by all existing sensory signals in a non-additive fashion. Individual perception of the sensory structure appears to be a significant component of the response to these protocols and underlies much of the observed response variability. CONCLUSION: The ability to provide new technology for rehabilitation services is emerging as an important option for clinicians and patients. The use of data mining software would help analyze the incoming data to provide both the patient and the therapist with evaluation of the current treatment and modifications needed for future therapies. Quantification of individual perceptual styles in the VE will support development of individualized treatment programs. The virtual environment can be a valuable tool for therapeutic interventions that require adaptation to complex, multimodal environments.

Journal Article↗
PubMed1994

Changes in proliferating cell nuclear antigen expression in glioblastoma multiforme cells along a stereotactic biopsy trajectory.

Proliferating cell nuclear antigen, an auxiliary protein of deoxyribonucleic acid polymerase-delta, has been shown to be a reliable marker of nuclear deoxyribonucleic acid synthetic activity. We applied a monoclonal antibody to proliferating cell nuclear antigen to a series of serial stereotactic biopsies from patients with glioblastoma multiforme and found the proliferative activity to vary relative to biopsy location within or surrounding the solid tissue component of the tumor. Twenty-seven trajectories in 26 patients were analyzed, each consisting of two to five sequential 10 x 1.5 mm core biopsies (mean = 3). The proliferative index (PI) was greatest in those cells located at the solid tumor-infiltrated parenchyma interface. PI values were significantly lower in those biopsy cores located proximal (within infiltrated parenchyma) and distal (within solid tumor tissue) to the solid tumor-infiltrated parenchyma interface (median PI values, proximal to distal: 0.38, 0.66, 5.45 solid tumor-infiltrated parenchyma interface], 0.39, 0.09%). The mean PI values were significantly lower in neoplastic cells samples from regions of peripheral hypodensity on computed tomographic scans compared with those sampled from contrast-enhancing regions (0.9 and 3.91%, respectively). There was no significant difference in the mean PI values of neoplastic cells sampled from regions of contrast enhancement or central hypodensity (3.91 and 4.31%, respectively).

Biomarkers, Tumor↗
PubMed2000

[Occurrence of BOOP outside radiation field after tangential radiation therapy for breast carcinoma].

We report three cases of bronchiolitis obliterans organizing pneumonia (BOOP) that occurred outside the radiation field after radiation therapy using tangential fields for breast carcinoma. All patients complained of a cough between 14 and 20 weeks after completion of radiation therapy. Fever also developed in two of the three. Chest radiography and computed tomography demonstrated peripheral alveolar opacities outside the radiation field on the same side as the radiation therapy. Laboratory data showed an increased level of C-reactive protein and an increased erythrocyte sedimentation rate. Bronchoalveolar lavage showed an elevated total cell count with a very high percentage of lymphocytes. Transbronchial lung biopsy revealed a histologic pattern consistent with BOOP. Treatment with corticosteroids resulted in rapid clinical improvement and complete resolution of the radiographic abnormalities. This pulmonary disorder appears to be induced by radiation, especially when a tangential field is employed for breast carcinoma, though the etiology has not been fully investigated. It is important to be aware of this type of pulmonary complication in patients given radiotherapy for breast carcinoma.

Breast Neoplasms↗
PubMed2001

[Occurrence of BOOP outside radiation field after radiation therapy for small cell lung cancer].

We report a case of bronchiolitis obliterans organizing pneumonia (BOOP) that occurred outside the radiation field after radiation therapy for small cell lung cancer. A 74-year-old woman received chemotherapy and a total of 60 Gy of radiation therapy to the right hilum and mediastinum for small cell carcinoma of the suprahilar area of the right lung. Radiation pneumonitis developed within the radiation port 3 months after the completion of radiation therapy. She complained of cough and was admitted 7 months after completion of the radiation therapy. Chest radiography and computed tomography demonstrated peripheral alveolar opacities outside the radiation field on the side contralateral to that receiving the radiation therapy. Bronchoalveolar lavage showed that the total cell count was increased, with a markedly increased percentage of lymphocytes. Transbronchial lung biopsy revealed a histologic pattern consistent with BOOP. Treatment with corticosteroids resulted in rapid improvement of the symptoms and complete resolution of the radiographic abnormalities of the left lung. Although some cases of BOOP following radiation therapy for breast cancer have been reported, none of BOOP after radiation therapy for lung cancer have appeared in the literature.

Aged↗
PubMedDate not supplied

[Circulatory and metabolic disturbances in accidental hypothermia (author's transl)].

This work sums up several studies: clinical observation (electrocardiogram, cardiac rhythm, circulatory state), and biology (glycemia, blood oxygenation, acid-base balance) in 24 cases of accidental hypothermia, not related to poisoning by central nervous system depressive agents; haemodynamics in 18 of these cases; pathology of the myocardium in 11 cases; haemodynamics and microscopy of the myocardium in dogs with slowly induced or prolonged hypothermia; finally an electron microscope study in hypothermic rats. Electrocardiographic study and continuous monitoring of cardiac rhythm and tracing show, in addition to well known manifestations (bradycardia, lenghtening of QT, J wave), acute dysrhythmias, particularly circulatory arrests by asystole during or even 72 hours after rewarming. The clinical haemodynamic changes, measurable (cardiac output, mean arterial pressure, central venous pressure), or computable (stroke volume, peripheral resistances) are observed during rewarming. Several haemodynamic developments can be distinguished: --favourable evolution when the initial disturbances (decrease in cardiac output and in stroke volume, increase in peripheral resistances) disappear without any therapeutic support: --haemodynamic developments showing at a certain time evidence of hypovolemia requiring only moderate vascular replacement; --haemodynamic developments showing myocardial damage. In some cases, only hypothermia accounts for these. In circulatory arrests during or after rewarming, these haemodynamic disturbances raise the hypothesis of severe cardiac changes due to hypothermia itself.

Acid-Base Equilibrium↗
PubMed1992

[Epidemiology of osteoporosis].

A representative inquiry (n = 4217) in Zürich revealed that 22% of the female population eats a diet poor in calcium. A connection between calcium-deficient nutrition and other unhealthy lifestyles such as lack of exercise, smoking (> 10 cigarettes/day) and regular alcohol intake (several glasses/day) has been shown by multivariate analysis. Therefore one has to suspect, that every third to fourth woman having several risk factors is at risk at entry in menopause. Primary prevention as a population-oriented strategy is therefore sought by general health-education and prevention of accidents in order to lower risks for fractures. Fractures of the collum femoris alone are on the basis of actual life expectancy in Switzerland responsible for 157,000 hospital days in women and 18,000 in men, corresponding to the annual capacity of an acute-cave hospital with 500 beds. With the aid of a risk-group strategy therefore attempts at secondary prevention are necessary. As a cost-effective screening-test every postmenopausal woman should receive a peripheral quantitative computer-tomography. Women with relatively high bone loss-rates and/or low bone density (insufficient stability) could thus be recognized and offered the benefit of an individualized compliance-promoting protective treatment.

Adult↗
PubMed1991

[A method of studying carbohydrate metabolism].

A new method of studying carbohydrate metabolism is described. It involves glucose injection according to a certain glucose law, followed by measurement of the dynamics of its concentration in the peripheral blood and computation, based on the models suggested, of the quantitative characteristics of metabolism; compartment of glucose distribution, maximum assimilation of glucose from its supply, and so forth. The individual characteristics of carbohydrate metabolism are shown to change within broad ranges (from 0.92 to 0.11 g/min). Materials on the method reproducibility are provided.

Blood Glucose↗
PubMed1986

[X-ray computed tomographic aspects of tumors of the colon with peripheral extramucous development].

The authors report three cases of a palpable abdominal mass without clinical evidence of obstruction. In each case, ultrasound diagnosed a solid tumor. Computer tomography examination measured the density of the tumor and the extension of the disease. In each case, the colonic origin was established owing to surgery. Histological examination of the three cases diagnosed a fibroma of the caecum, an enterogenic cyst of the caecum and a T-lymphosarcoma developed from the wall of the left colon.

Adult↗
PubMedDate not supplied

Primary peripheral T-cell lymphoma of the face other than mycosis fungoides. Computed tomography and magnetic resonance findings.

OBJECTIVE: To describe the radiologic findings of primary peripheral T-cell lymphoma (PTCL) of the face other than mycosis fungoides. METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) findings of 5 consecutive patients with pathologically proven primary facial PTCL other than mycosis fungoides were retrospectively evaluated. Patients with PTCL involving the sinonasal cavity or lymph nodes were excluded. RESULTS: Diagnoses of patients included in this study consisted of natural killer/T-cell lymphoma (n = 2), subcutaneous panniculitis-like T-cell lymphoma (n = 1), anaplastic large cell lymphoma (n = 1), and PTCL not otherwise specified (n = 1). Infiltration or swelling of the superficial space of the face was noted on both CT and MRI, mimicking inflammation or infection. Also seen were well-enhancing small nodular (n = 2) or infiltrative mass-like lesions (n = 2) within the areas of infiltration, which showed intermediate signal intensity on T2-weighted images. One patient demonstrated infiltration and swelling alone. CONCLUSIONS: Primary facial PTCL is a rarely encountered tumor and demonstrates infiltration or swelling mimicking inflammation or infection. Nodular or infiltrative mass-like lesions may be helpful for its diagnosis.

Adult↗
PubMed1987

Performance evaluation of density measurements of axial and peripheral bone with x-ray and gamma-ray computed tomography.

We examined sources of error in bone measurements made with computed tomography (CT) using a whole-body scanner (GE 8800) and a peripheral-bone CT scanner (developed at the University of Alberta). We investigated the influence of various factors on trabecular bone density: homogeneity and noise in the image plane, linearity of calibration, body size, effects of cortical bone, and the image analysis procedure. With the GE 8800 scanner, the precision (SD) of measurements of a single vertebra is expected to be +/- 1.65% (noise: +/- 0.22%, calibration: +/- 1.3%, analysis: +/- 1%); the accuracy, excluding consideration of marrow fat, varied between -2.7 and +7.3% (compact-bone thickness: 2-5%, body size: -2.5 - +1.5%, calibration: -0.47 - +0.77%). With the peripheral-bone CT scanner, the total precision error (+/- 0.53%) was dominated by noise, with only a minor contribution from the analysis procedure (+/- 0.04%); accuracy varied between -0.6 and +3.4% (effect of cortical bone: up to 3.0%; changes in size of object: -0.59 - +0.4%). The magnitude of these errors was determined under 'ideal' conditions, mostly through phantom measurements; therefore, the errors represent optimistic lower limits in clinical application. Furthermore, measurements of density of cortical bone were not reliable for bone thicknesses of less than about 4 mm with the GE 8800 scanner and less than about 1.5 mm with the peripheral scanner.

Absorptiometry, Photon↗
PubMed1996

Surgery for biliary obstruction by tumour thrombus in primary liver cancer.

Five patients with primary liver cancer presented with obstructive jaundice due to extension of tumour thrombus into the biliary ducts. Three patients had hepatocellular carcinoma, two of whom had alcoholic cirrhosis, and the other two had a peripheral cholangiocarcinoma. Preoperative diagnosis of biliary thrombus was best achieved by ultrasonography and computed tomography which showed peripheral hepatic tumour with dilated bile ducts containing dense material. All patients underwent liver resection associated with biliary exploration, clearance and T-tube drainage. Major hepatectomy was required in four cases. There were no postoperative deaths; one patient developed a subphrenic collection of bile which was drained percutaneously. All patients survived more than a year; median survival was 29 months. There are two long-term survivors without recurrence at 29 and 80 months. Patients with primary liver cancer and jaundice due to migrated tumour fragments in the common bile duct may benefit from surgical resection which can result in long-term resolution of symptoms and occasional cure.

Carcinoma, Hepatocellular↗