Biomedical subjects
Publications and source records attributed to A R Wilson.
Fibromatosis of the breast is an uncommon disease, although several series of this condition in females have been reported in the literature. We present the first case to be described in a male patient.
The objective of this study was to evaluate the relation between runoff vessels and the prognosis in patients who have had an occlusion of a previously placed peripheral arterial bypass graft. Over a 4-year period 77 occluded synthetic grafts were treated with urokinase and reconstruction after angiographic study. Follow-up ranged from 1 to 1627 days. The cases were divided into three groups according to the number of patent tibial vessels. Group I consisted of patients who had no vessel runoff. Group II consisted of patients who had single vessel runoff. Group III consisted of patients who had two or three runoff vessels. In Group I, the 1, 2, and 3-year patency rates were 35.8%, 8.9%, and 8.9%; and the limb salvage rates were 50.2%, 40.2%, and 40.2% for 1, 2, and 3 years, respectively. The Group II patency rates were 31.2%, 26.0%, and 13.0% and the limb salvage rates were 72.3%, 62.9%, and 62.9%. The Group III patency rates were 50.0%, 26.1%, and 20.9%; and the limb salvage rates were 93.1%, 79.1%, and 79.1%. There is no statistically significant difference in patency rates among any of the groups. The limb salvage rate was significantly increased in Group III, compared to I (P < 0.01) and Group II (P < 0.05), and in Group II, compared to Group I (P < 0.05). These results indicate that the higher rate of limb salvage in this study statistically correlated with the number of runoff vessels.
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Tricho-dento-osseous syndrome is a rare autosomal dominant hereditary disorder characterized by curly hair, enamel hypoplasia, taurodont teeth, and thickened cortical bone. A large kindred with this syndrome has been identified in North Carolina and characterized by pedigree analysis and clinical evaluation. Hair samples (N = 3) and an exfoliated primary tooth (N = 1) from persons with tricho-dento-osseous syndrome and hair and teeth from unaffected persons were examined. Scanning electron microscopy showed that the hair shaft morphology, diameter, and cuticular pattern and periodicity were similar for the tricho-dento-osseous syndrome and control samples. The affected tooth was examined using light microscopy and a scanning electron microscope that showed pitting hypoplasia of the enamel surface, an extremely large pulp chamber, and dentin that appeared structurally normal. The affected enamel was uniformly thin, only 10% the thickness of the control enamel. The bulk of this enamel showed no prism formation. This study indicates that although hair with tricho-dento-osseous syndrome often is clinically curly, it can be straight, and it does not appear to have unique ultrastructural features that are of diagnostic benefit. The dental characteristics of tricho-dento-osseous syndrome were the most consistent feature seen in this kindred.
The outcome of short-term recall for the follow-up of 131 screen detected 'probably benign' non-palpable mammographic lesions is presented. Patients were selected for short-term recall after attending a dedicated assessment clinic and underwent repeat ipsilateral mammography 1 year later. Interval progression in the mammographic appearance prompted excision biopsy, whereas no change led to discharge back to the normal screening protocol. Of 35,671 asymptomatic women screened between 1988 and 1992, 1762 (5%) attended an assessment clinic. Subsequently, 131 women (7% assessed, 0.4% screened) were placed on short-term recall and were reviewed between 1989 and 1993 (age range 50-67 years). The 'probably benign' lesions were: calcifications (91 cases, 69%); circumscribed density (18 cases, 14%); parenchymal deformity/stellate density (13 cases, 10%); and asymmetric breast tissue (9 cases, 7%). 128/131 women attended for short-term recall (compliance 98%). Five from 128 were subject to excision biopsy with a yield of three invasive carcinomas and two ductal carcinomas in-situ. The positive predictive values for malignancy were: overall 'probably benign' lesions (PPV 3.9%); calcifications (PPV 3.3%); circumscribed density (PPV 0%); parenchymal deformity/stellate density (PPV 15.4%); and asymmetric breast tissue (PPV 0%). The largest carcinoma measured 15 mm and none of the tumours demonstrated vascular invasion or axillary metastases placing them in a favourable prognostic group. The results suggest that short-term recall is a reasonable management option for a small number of women with 'probably benign' calcifications. Parenchymal deformity and stellate densities should probably not be managed by this approach and require excision after initial assessment. Circumscribed densities and asymmetric breast tissue can be safely discharged following assessment.
Invasive cribriform carcinoma (ICC) of the breast is characterized by a cribriform histological architecture. It is rare, accounting for 0.6% of breast cancers in Nottingham and has an excellent prognosis. Its radiological features have not been previously described. Preoperative mammograms were available in eight cases (6 symptomatic, 2 screen-detected) and preoperative ultrasound examinations in four. The tumour was mammographically occult in four (50%) cases. The four tumours which were visible on mammography all showed as a large (20-35 mm) spiculated mass and two contained a few flecks of punctate calcification. The ultrasound appearances were not entirely typical of breast carcinoma. Three of four showed an ill-defined, inhomogeneous solid mass, but without the distal acoustic attenuation found in 60-97% of other forms of breast carcinoma. We conclude that ICC has imaging characteristics distinct from tubular carcinoma, which is its closest histological analogue.
PURPOSE: C-erbB-2 oncogene expression is found in 60% of DCIS cases. C-erbB-2 expression in DCIS has been shown to correlate with comedo subtype, large cell size, lymphoid infiltrate, nuclear pleomorphism, multinucleation and high mitotic rate. These findings have led to the suggestion that the subgroup of DCIS that expresses c-erbB-2 may be a biologically definable category with prognostic significance. The purpose of this study was to identify any differences in the mammographic appearances between DCIS which expresses c-erbB-2 and DCIS that does not express this oncogene. MATERIALS AND METHODS: C-erbB-2 staining characteristics and preoperative mammograms were available for review in 126 patients with pure DCIS. All the mammograms were reviewed by a radiologist knowing the patient had DCIS but without any further pathological or immunohistochemical information. RESULTS: C-erbB-2 positive DCIS showed the following features more commonly than c-erbB-2 negative disease: calcification (65 of 71 (92%) vs 28 of 39 (72%), P < 0.01), ductal distribution of calcification (51 of 65 (78%) vs 16 of 28 (57%), P < 0.05), rod-shaped calcification (53 of 65 (82%) vs 15 of 28 (54%), P < 0.01) and granular calcification (63 of 65 (97%) vs 24 of 28 (86%), P < 0.05). C-erbB-2 negative DCIS more commonly showed an abnormal mammogram without calcification than c-erbB-2 positive disease (11 of 39 (28%) vs 6 of 71 (8%), P < 0.01). CONCLUSION: We have demonstrated significant differences in the mammographic features of c-erbB-2 positive and negative disease. As c-erbB-2 expression has been shown to correlate with aggressive histological features, the differences in the mammographic appearances between c-erbB-2 positive and c-erbB-2 negative DCIS may be of practical value.
The objective of this study was to evaluate the efficiency of multiple vascular reconstructive procedures in the presence of an occluded synthetic graft. Over a four year period seventy-seven occluded synthetic grafts were treated with urokinase and reconstruction. Follow-up ranged from 1 to 1627 days (4 years, 5 1/2 months). Kaplan-Meier and generalized Wilcoxon test were used to determine patency and limb salvage rates. The cases were divided into three groups according to the number of previous reconstructive events. Group I consisted of patients that had undergone one previous vascular reconstructive procedure. Group II consisted of patients that had undergone two previous vascular reconstructive procedures. Group III consisted of patients who had undergone three or more previous reconstructive procedures. In Group I, the one, two, and three year patency rates were 48.6%, 34.7%, and 26.0% and the limb salvage rates were 76.2%, 67.9%, and 67.9% for one, two, and three years respectively. The Group II patency rates were 41.9%, 24.4%, and 16.3% and the limb salvage rates were 73.7%, 66.3%, and 66.3%. The Group III patency rates were 31.8%, 5.5%, and 5.5% and the limb salvage rates were 76.6%, 54.8%, and 54.8%. The patency rate was significantly reduced when Group III was compared to Group I (p < 0.01). There was no statistically significant difference in limb salvage rates between any of the groups. These results indicate that the number of secondary vascular reconstructive procedures combined with thrombolysis had no correlation with the prognosis of limb salvage.(ABSTRACT TRUNCATED AT 250 WORDS)
PURPOSE: The authors evaluated the role of transcranial Doppler ultrasonography (US) in patients with sickle cell disease (SCD) and cerebrovascular disease. MATERIALS AND METHODS: Twenty-one patients with SCD and stroke (aged 3-22 years; mean age at stroke, 9 years) were evaluated with magnetic resonance (MR) imaging and duplex transcranial Doppler US with a 2-MHz transducer. Nineteen patients also underwent MR angiography. Forty-six asymptomatic patients with SCD were also evaluated with Doppler US, MR imaging, and MR angiography. RESULTS: The following transcranial Doppler US findings were correlated with cerebrovascular disease in patients with SCD: (a) maximum velocity in the ophthalmic artery (OA) of more than 35 cm/sec; (b) mean velocity in the middle cerebral artery (MCA) of more than 170 cm/sec; (c) resistive index in the OA of less than 50; (d) velocity in the OA greater than that of the ipsilateral MCA; and (e) maximum velocity in the posterior cerebral, vertebral, or basilar arteries greater than the maximum velocity in the MCA. CONCLUSION: Transcranial Doppler US scanning has great potential as an inexpensive, easily performed screening procedure for cerebrovascular disease in patients with SCD.
Intestinal perforation is a common and serious complication of NEC in neonates. Plain film evidence often is absent in patients with surgically proved perforation. Some patients with NEC develop a distended, gasless abdomen suitable for sonographic evaluation. Five neonates with gasless abdominal distention and clinical decline were studied with ultrasonography. Four patients demonstrated intraperitoneal fluid-debris levels and ascites; all had surgical proof of perforation. The fifth patient did not demonstrate these findings and subsequently recovered. The sonographic findings of ascites and intraperitoneal fluid-debris levels in patients with NEC are suggestive of perforation.
Flow cytometry is used to obtain estimates for the distribution of fluorescent ligands bound to cell surface receptors throughout a cell sample. The equipment used provides light scattering parameters and also cell staining data in the form of dot plots and histograms of fluorescence intensities and the frequency of occurrence of particular fluorescence intensities. It is then assumed that fluorescence intensity is proportional to the number of labelled ligands bound to surface receptors. In this paper we present an outline of a statistical theory to account for the stretching and translation of such flow cytometry profiles which occur either as a result of alterations in gene expression, or from changing the sub-saturating concentration of fluorescent-labelled monoclonal antibodies or lectins used to stain the cells. We describe how the theory has been incorporated into two programs CSAFIT (cell surface antigen fit) and MAKCSA (make data to test CSAFIT). The program CSAFIT can be used to estimate two parameters, alpha and beta, by constrained non-linear regression analysis of the flow cytometry profiles. If the shift results from changes in the concentration of a staining agent then the estimates alpha and beta calculated by CSAFIT are functions of the ligand concentration, the ligand type and the cell line characteristics. They quantify the stretch and translation events that are encountered in flow cytometry. So when the parameter estimates alpha and beta are then further analysed as functions of ligand concentration, estimates for the average association constant K for the binding-site/ligand interaction can be obtained. This paper describes details of the development of programs CSAFIT and MAKCSA. We also discuss the distribution of parameter estimates calculated by CSAFIT and the overall performance of CSAFIT as assessed by simulation studies using data generated by MAKCSA.
The objective of this study was to evaluate the impact of thrombolysis of synthetic grafts before urgent vascular reconstruction. In 29 patients, 41 thrombosed synthetic grafts that underwent intraarterial thrombolysis were studied. The cases were divided into three groups: group I--complete thrombolysis followed by reconstruction; group II--complete thrombolysis alone; and group III--incomplete lysis requiring reconstruction or sympathectomy. Follow-up ranged from 1 to 556 days (mean: 149 days). Kaplan-Meier analysis was used to determine patency and limb salvage rates. One-year patency and limb salvage rates were 53% and 95%, 34% and 67%, and 38% and 48%, respectively, for groups I, II, and III. Eighteen complications occurred in 16 of the 41 (39%) episodes. One patient died of intracranial hemorrhage. The best results were achieved when complete lysis was followed by appropriate reconstruction. Patency was equally poor in complete thrombolysis alone and reconstructions required by incomplete thrombolysis. Limb salvage was better after complete thrombolysis, regardless of the appropriate reconstruction.
Many complications are known to occur in association with congenital diaphragmatic hernia. Acute pancreatitis in this situation is very rare. A case is reported and guidelines are given for the management of this complication.
To evaluate the place of mammography in the selection of patients for excision and radiotherapy for primary breast cancer a detailed analysis of pre-operative mammograms was performed in (i) a study group of 37 patients who developed local recurrence; (ii) a matched control group with a median local recurrence free survival of 57 months. There were significantly more multifocal tumours in the study group. Tumours were significantly larger (P = 0.02) and closer to the nipple (P = 0.008) in the study group compared to the control group. Regular follow-up mammograms were available in 26 of the study group. Twenty-one patients had mammographic evidence of either residual or recurrent tumour. We conclude that pre-operative mammography is essential in the selection of patients for excision and radiotherapy. Following treatment, mammography is useful in detecting residual or recurrent disease.
Five patients with acquired coronal clefts in lower lumbar vertebral bodies are presented. The appearances on plain radiographs, skeletal scintigraphy, discography, computed tomography and magnetic resonance imaging (MRI) are described. The aetiological factors are discussed with particular emphasis on the role of the intervertebral disc and the discovertebral junction in the pathomechanics of vertebral body injury. Magnetic resonance imaging was helpful in the radiological assessment and provided information from which an explanation of the clefts could be proposed.
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The effects on respiratory function during intravenous urography of the ionic contrast medium sodium iothalamate and the non-ionic contrast medium iopamidol were compared. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were recorded in 37 non-atopic patients referred for intravenous urography. Nineteen patients received iopamidol and 18 patients received sodium iothalamate. Both the sodium iothalamate and the iopamidol groups showed a significant fall in FEV1 and FVC (P less than 0.001). The reductions in FEV1 and FVC were comparable and were not symptomatic. The differences in the percentage changes of the FEV1 and FVC in the iopamidol and the sodium iothalamate groups were not statistically significant (P greater than 0.5 and P greater than 0.1 respectively). No significant change in the ratio of the FEV1 and the FVC was demonstrated in either the iopamidol or the sodium iothalamate groups. Both the ionic and the non-ionic contrast media produced a measurable but asymptomatic and biologically insignificant fall in static ventilatory function. Bronchospasm does not appear to be an important contrast-induced effect in non-atopic individuals. Iopamidol offers no advantage over sodium iothalamate with respect to ventilatory effects in non-atopic patients undergoing intravenous urography.