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Biomedical subjects

A Butler

Publications and source records attributed to A Butler.

At least 127 records · Page 7Linked to original sources
PubMed1985

Postradiation osteogenic sarcoma of bone and soft tissues. A clinicopathologic study of 66 patients.

Sixty-six patients with well-documented osteogenic sarcomas arising in bones and soft tissues after exposure to x-rays, which represent approximately 5.5 percent of all osteogenic sarcomas registered since 1921 at this institution, were studied. These secondary sarcomas occurred in equal proportion in both sexes, with the sixth decade of life being the most common age. In 42 patients, the bone had been normal at the time of irradiation, whereas in 24, the radiation was directed against an osseous tumor or tumor-like lesion. The median latent period was 10.5 years in both groups, ranging from 3.5 to 33 years. The radiation varied from diagnostic quality to 1 MeV x-rays. The dose was variable, but none was less than 2000 rads. Postradiation osteogenic sarcomas most commonly arose in the bones of the pelvic and shoulder regions. Histologically, the sarcomas were mostly of the fibrous type (46%) and radiographically showed a destructive bone lesion with or without signs of radiation osteitis. The cumulative disease-free survival rate at 5 years was 17%, with a median survival estimate of 1 year.

Adult↗
PubMed1984

Mental distress in mothers of young children in Harrogate.

Two hundred and forty women with young children who were patients in a Harrogate general practice were studied. About a third of them were found to be suffering from 'mental distress'. Younger mothers were more affected. The number of spacing of their children were not related to symptoms of depression and anxiety, but poor personal relationships and difficulties getting out and about were so related, despite relatively affluent circumstances. Children of distressed mothers were more inclined to be disturbed. A controlled trial using amitriptyline involving 25 of the women suggested that this drug can improve depressive symptoms under these circumstances and that the improvement is likely to be maintained over the course of a year.

Adult↗
PubMed1983

Osteogenic sarcoma in the American black.

This clinicopathologic study of 100 American black patients with osteogenic sarcoma diagnosed and treated at this Medical Center from 1921-1979, inclusive, demonstrates a progressively increasing proportion of black patients admitted for this disease. The relative upsurge became especially pronounced in the 1970s. The ages of the patients ranged from 3 to 58 years (median, 16, mean 19.2 years). The age distribution shows that blacks, on the whole, are younger than whites when they develop these tumors, and this is particularly evident in the black girls. Skeletal locations for osteogenic sarcomas, in general, are similar in both races, except that the tibia and the fibula were involved significantly more frequently in the blacks while the humerus was afflicted less commonly. The clinical stage of disease on presentation, the duration of signs and symptoms, the histologic subclassification of the tumors, and the radiographic appearances closely matched in both races. The numbers of patients with Paget's sarcomas were also evenly distributed. Twenty-nine patients are currently alive with the 2-year and 5-year disease-free survival being 42% and 32%, respectively. There are no differences in the survival of black as compared to white patients, either for the entire duration of the study or for the period after 1974. The poorer prognosis of cancer in blacks does not apply to osteogenic sarcoma patients.

Adolescent↗
PubMed1983

Osteogenic sarcoma associated with Paget's disease of bone. A clinicopathologic study of 65 patients.

Among 1177 osteogenic sarcoma patients diagnosed and treated at Memorial Hospital, 65 (5.5%) were associated with either monostotic or polyostotic Paget's disease. The overall median age was 64 years (range, 39-82 years). In those patients older than 40 years of age, the frequency of sarcomatous transformation rose to 27%. There were slightly more men (55%) than women. The most common skeletal sites were the pelvic bones (34%), the humerus (22%), the femur (19%), and the craniofacial bones (14%). Unrelenting pain and tender swelling were the most common presenting symptoms (85%), with pathologic fracture in 14 (22%) patients. In two-thirds of the cases, the radiographic presentation was that of a lytic destructive lesion; while in the others it showed a sclerotic, mixed, or permeative character. In almost one-half of the cases, the histologic appearance of the osteogenic sarcomas was either fibrohistocytomatous or osteoblastic. In spite of radical surgical amputations, only three patients survived longer than 5 years. The prognosis of Paget's sarcoma is significantly less favorable than in osteogenic sarcoma arising de novo in patients of comparable age.

Adult↗
PubMed1983

Metastatic adenocarcinoma presenting as bilateral blindness.

A 71-year-old man had bilateral shallow retinal detachments. An extensive medical work-up was unrevealing. A "skinny-needle" biopsy of retrocrural lymph nodes under computed tomographic control supported a diagnosis of metastatic adenocarcinoma to his choroid. A review of the literature on metastatic ocular cancer is presented.

Adenocarcinoma↗
PubMed1982

Telangiectatic osteogenic sarcoma: a clinicopathologic study of 124 patients.

One hundred-twenty-four patients with this rare and special variant of osteogenic sarcoma were treated at Memorial Sloan-Kettering Cancer Center from 1921 through 1979, representing 11% of all of osteogenic sarcomas. The lesions were predominantly lytic, destructive tumors with only minimal sclerosis on roentgenograms and soft as well as cystic on gross examination. Histologically, aneurysmally dilated spaces lined or traversed by sarcoma cells producing osteoid were noted. The differential diagnosis both radiographically and histologically included several benign lesions like aneurysmal bone cyst and giant cell tumor, among many others. It was found that telangiectatic osteogenic sarcoma is relatively frequent in the femoral diaphysis and in the distal end of the femur. Twenty-nine percent of the patients present with pathologic fracture, or this develops later. Age and sex distribution, or clinical signs or symptoms were those of ordinary osteogenic sarcomas. No differences in survival rates were found in lesions that were purely lytic or those with minimal sclerosis. Similarly, no differences in survival were noted when comparing patients with telangiectatic or ordinary osteogenic sarcoma. As a matter of fact, definite increase in survival was found in patients treated since 1975 with preoperative multidrug chemotherapy employing high-dose methotrexate. Adriamycin, and the combination of bleomycin, cyclophosphamide, and dactinomycin.

Adolescent↗
PubMed1981

Estrogen receptor protein in breast cancer as a predictor of recurrence.

Estrogen receptor protein (ERP) determinations of primary cancers of 1034 patients with primary breast cancer were done. ERP-positive patients tended to have a lower recurrence rate and had significantly improved survival. This difference was most apparent in patients with four or more axillary nodes involved. ERP-positive patients who recurred had a better survival. ERP did not influence response that adjuvant chemotherapy, nor did the presence of progesterone receptor or femtomole level of ERP affect recurrence.

Breast Neoplasms↗
PubMed1981

The parents of school phobic adolescents - a preliminary investigation of family life variables.

Parents were interviewed at home in a preliminary study of family life variables. Forty-eight had children admitted to an adolescent in-patient unit, 19 of them for school phobia and the remainder because of other psychiatric conditions. Difficulty in obtaining a comparable group from the normal school population resulted in only 12 such families being studied in addition. The psychiatric cases were reliably separated into school phobic and other problems. Practically all the school phobics had neurotic disorders. Contact of parents with relatives and friends, their leisure activities outside the home, their patterns of work and their management of domestic affairs, were looked at. It was thought that these aspects of family functioning might be distinctive where there was a school phobic youngster and that an abnormal pattern of family life might predispose a child to this disorder. In fact, no evidence emerged to suggest that parents of school phobic adolescents participate in, or make decisions about, family life activities in any way different from parents of other psychiatric cases or normal controls.

Adolescent↗
PubMed1981

Cardiac catheters for diagnosis and treatment of venous air embolism: a prospective study in man.

One hundred consecutive patients undergoing neurosurgical procedures in the seated position were monitored for venous air embolism with a Swan-Ganz pulmonary artery (PA) catheter, precordial Doppler ultrasound device, and continuous end-tidal CO2 (FETCO2) analysis. Simultaneous determinations of right atrial and pulmonary capillary wedge pressures were also performed during each operation. Although 80 episodes of air embolism were detected by changes in Doppler sounds, only 36 were associated with increased PA pressure, and only 30 developed a decrease in FETCO2. Changes in PA pressure and FETCO2 agreed closely (r = 0.86), and only marked changes were associated with systemic hypotension. Air was recovered from the right atrium and PA only in small amounts (2 to 20 ml) during air embolism, although it was possible to aspirate large quantities of blood. Twenty-nine patients were found to have right atrial pressures that were higher than pulmonary capillary wedge pressures. Paradoxical air embolism from a probe-patent foramen ovale was possible in these patients, and one developed signs and symptoms of systemic air embolism postoperatively. We conclude that noninvasive monitoring with the combination of a precordial Doppler device and end-tidal CO2 analysis is satisfactory for rapid detection of clinically significant venous air embolism. The unique advantage of Swan-Ganz monitoring, however, is that it permits identification of patients who may sustain paradoxical air embolism, and that it differentiates the hemodynamic effects of brain-stem manipulation from those caused by air embolism.

Blood Pressure↗
PubMed1980

The role of craniectomy in the treatment of chronic subdural hematomas.

A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.

Aged↗
PubMed1980

"Microgranular" acute promyelocytic leukemia: a distinct clinical, ultrastructural, and cytogenetic entity.

Three patients with acute leukemia, disseminated intravascular coagulation, and a specific acquired chromosome abnormality [t (15;17)] were found by transmission electron microscopy to have the typical distribution of granules seen in promyelocytes. However, the average granule sizes were 120, 170, and 180 nm, respectively, for the three patients, significantly less than the 250-nm resolution of light microscopy. We regard the leukemia in these three patients as comprising a distinct clinical, ultrastructural, and cytogenetic entity that we have chosen to call "microgranular" acute promyelocytic leukemia.

Adult↗
PubMed1980

Lidocaine or thiopental for rapid control of intracranial hypertension?

The effectiveness of intravenously administered lidocaine for rapid control of acute intracranial hypertension was compared to the effectiveness of thiopental in 20 patients with brain tumors undergoing craniotomy. Despite normal radial arterial and intracranial pressures (ICP) after induction of N2O-O2-morphine anesthesia, mean ICP increased from 13.8 torr +/- 1.5 SE to 31 torr +/- 2.3 SE (p less than 0.001) in response to application of a pin-holder or scalp incision. To treat the elevated ICP a bolus injection of lidocaine, 1.5 mg/kg IV, was given to 10 patients, whereas the other 10 received thiopental, 3 mg/kg IV. Lidocaine reduced ICP 15.7 torr +/- 5.6 SE (p less than 0.025) did not significantly affect mean arterial pressure. In contrast, thiopental lowered ICP 18.4 torr +/- 9.6 SE (p less than 0.02) and also lowered mean arterial pressure by 26.1 torr +/- 9.6 SE (p less than 0.025). Mean time for injection of medication to ICP nadir was 66 seconds +/- 10 SE after lidocaine versus 48 seconds +/- 9 SE after thiopental (p greater than 0.20). It is concluded that lidocaine is as effective as thiopental for rapid reduction of intraoperative intracranial hypertension but that it causes less cardiovascular depression. Lidocaine may be of particular benefit to patients with both intracranial hypertension and marginal circulatory function.

Brain Neoplasms↗
PubMed1980

Epidural steroid effects on nerves and meninges.

There have been encouraging reports of symptomatic improvement in patients with low back pain following injection of a mixture of a local anesthetic and a corticosteroid into the lumbar epidural space. However, there is a lack of animal or human studies which examined possible long-term effects of this combination on the exposed neural tissues. This study evaluated by both light and electron microscopy the effect of triamcinolone diacetate in vehicle and of the vehicle itself (both in 2% lidocaine) in 48 cats after percutaneous epidural injections were done at the lumbosacral space. When the animals were killed at 30 or 120 days, specimens of the spinal root, the root exit zone, and the meninges at the level of injection and level above and below were obtained. Because all of the histologic findings were found to be mild, it is concluded that local anesthetic-steroid combinations do not cause significant damage to neural tissues.

Animals↗
PubMed1979

Inflammatory bowel disease in the West Indies.

Inflammatory bowel disease is generally assumed to be rare among negroes and Indians. Over 10 years 34 cases of ulcerative colitis and 14 cases of Crohn's disease were seen in one medical and one surgical unit in Port-of-Spain, Trinidad. Twenty-six patients were Negroes, 18 were Indians, three were of mixed race, and one was Caucasian. In many of these patients the disease was extensive and several of those with Crohn's disease suffered severe complications. The assumption that inflammatory bowel disease is rare among West Indians of African and Indian origin therefore seems to be wrong.

Adolescent↗
PubMed1978

Features of children taken to juvenile court for failure to attend school.

The social reports on 84 children taken to court for failure to attend school were studied. Independent raters were able to assess reliably the presence and absence of a variety of variables concerned with the individual's behaviour, school, family, and involvement with social work agencies. In 68 instances teacher's questionnaires measuring psychiatric disturbance had been completed. There was no evidence that truancy in these circumstances is a homogenous condition. At least 3 independent sets of features appear to be involved in most cases. One involves antisocial and educational problems ('clinical truancy'), a second is concerned with adverse social factors and parental complicity ('school withdrawal'), and a third set includes a tendency to social isolation ('school refusal'). There was no evidence that individuals tend to exhibit one of these features to the exclusion of the others.

Absenteeism↗