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Biomedical subjects

C D Phillips

Publications and source records attributed to C D Phillips.

At least 55 records · Page 3Linked to original sources
PubMed1995

A phase 1-2 trial of superselective carboplatin, low-dose infusional 5-fluorouracil and concurrent radiation for high-grade gliomas.

Recent trials have suggested that low-dose infusional 5-FU is more efficacious when given during radiotherapy than is bolus 5-FU. Additionally, intra-arterial cisplatin for brain tumors has been shown to be associated with both high response rates as well as significant toxicity. A dose escalation study was therefore performed using superselective carboplatin, a cisplatin analogue with a favorable CNS toxicity profile in combination with 6 weeks of infusional 5-FU at 225 mg/m2 and concurrent radiotherapy. Eight patients were treated at the starting dose of 200 mg/m2 carboplatin and 11 patients were treated at 300 mg/m2. No toxicity was observed that was attributable to infusional 5-FU. However, two ischemic events related to the superselective delivery of carboplatin were observed, and one patient was noted to have asymptomatic retinal toxicity from the carboplatin. Of 19 patients, 5 had objective responses with 25% or greater reduction in tumor volumes. Continuous infusional 5-FU can be given in combination with partial brain radiotherapy without significant toxicity. Superselective carboplatin delivery is associated with a low incidence of stroke, but no significant retinal toxicity.

Adult↗
PubMed1995

Chronic sinusitis: relationship between CT findings and clinical history of asthma, allergy, eosinophilia, and infection.

An interdisciplinary study from the University of Virginia was reported in a recent issue of the Journal of the American Medical Association (JAMA) [1]. The results of that study are pertinent to radiologists who interpret CT scans for patients with chronic sinus disease. The study examined the relationship among eosinophilia, asthma, allergy, and sinusitis and assessed the findings obtained for the paranasal sinuses by high-resolution CT. Soft-tissue disease seen within the paranasal sinuses on CT scans is often described as mucosal thickening or mucoperiosteal thickening, with little attention to its exact nature. The JAMA article showed that for patients properly prepared for sinus CT, the thickened mucosa depicted within the sinonasal cavity is a significant site of functional, immunologically active tissue. The purpose of this article is to bring the findings of the JAMA report to the attention of radiologists and to emphasize the imaging technique, findings, and clinical relevance of the results.

Asthma↗
PubMed1995

The value of CT in determining potential instability of simple wedge-compression fractures of the lumbar spine.

PURPOSE: To determine whether plain films alone are sufficient in the evaluation of stability of simple wedge-compression fractures of the lumbar spine. METHODS: Plain films and CT scans of 53 consecutive patients seen during a 2-year period with lumbar spine fractures were retrospectively reviewed. Six readers blinded to the CT diagnosis independently read each patient's plain films. Plain-film findings were scored on a five-point graded response scale using criteria proposed by Gehweiler and Daffner. In addition, a fracture was considered to be possibly unstable if there was involvement of more than one vertebral level or greater than 50% loss of anterior vertebral body height. CT findings represented the standard for comparison. CT scans were independently evaluated by three additional readers. Two-column involvement, middle-column involvement alone but with retropulsion, multiple-level involvement, or greater than 50% loss of vertebral height indicated potential instability. RESULTS: For 14 stable and 39 potentially unstable lumbar spine fractures, the pooled (mean) plain-film negative predictive value for detection of potentially unstable fractures was 0.62 (95% confidence interval, 0.53 to 0.70), with a sensitivity of 0.83 (95%, confidence interval; 0.78 to 0.87), and specificity of 0.80 (95% confidence interval, 0.70 to 0.87). CONCLUSION: Plain films are not adequate for determining stability of lumbar spine fractures.

Diagnosis, Differential↗
PubMed1995

Multivariate analysis and prediction of outcome following penetrating head injury.

Schemes for predicting outcome in craniocerebral missile injury have ranged from Cushing's analysis that was based on the physical characteristics of the injury to complex logistic analyses that incorporate radiographic, laboratory, and clinical data. Generation of predictive scales is discussed, focusing on the utility of the Glasgow Coma Scale (GCS) score at presentation, presence or absence of coagulopathy, and radiographic evidence of the volume and type of tissue damage.

Brain Injuries↗
PubMed1994

Chronic sinusitis. Relationship of computed tomographic findings to allergy, asthma, and eosinophilia.

OBJECTIVE: To develop a technique for evaluating the severity of chronic sinus disease and to examine the correlation with allergy, asthma, and eosinophilia. DESIGN: A survey of 104 patients undergoing surgery for chronic sinusitis. SETTING: A university hospital ear, nose, and throat clinic. PATIENTS: A referral population of adult patients being scheduled for endoscopic sinus surgery was eligible; 104 completed questionnaires and agreed to participate. MAIN OUTCOME MEASURES: Computed tomographic scans were reviewed and scored for extent of disease. Serum samples were assayed for total IgE and specific IgE antibodies to common inhalant allergens. Peripheral blood samples were analyzed for total eosinophil count. Surgical biopsy specimens were examined for eosinophilia and cultured for bacteria and fungi. RESULTS: Extensive disease was present in 39% of subjects and correlated well with asthma, specific IgE antibodies, and eosinophilia, but not with elevated total IgE. Among patients with peripheral eosinophilia, 87% had extensive disease. All cultures grew aerobic bacteria; anaerobes and fungi were uncommon. CONCLUSIONS: We present a system for quantitation of disease extent using computed tomographic scans of patients with chronic sinusitis. The well-accepted associations of chronic sinusitis with asthma and allergy appear to be restricted to the group with extensive disease. The presence of peripheral eosinophilia in patients with sinusitis indicates a high likelihood of extensive disease.

Adult↗
PubMed1994

Computed tomographic study of the common cold.

BACKGROUND: Colds are common, but the abnormalities they produce in the nasal passages and sinus cavities have not been well defined. METHODS: We studied healthy adult volunteers with self-diagnosed colds of 48 to 96 hours' duration and obtained the following data: information on symptoms, computed tomographic (CT) studies of the nasal passages and sinuses, mucosal-transport times, measures of nasal-airway resistance, and viral-culture studies. Thirty-one subjects (mean age, 24 years) had complete evaluations, including CT scans, which were read without knowledge of the clinical data. An additional 79 subjects underwent the same evaluations, except the CT scans. RESULTS: Of the 31 subjects with CT scans, 24 (77 percent) had occlusion of the ethmoid infundibulum; 27 (87 percent) had abnormalities of one or both maxillary-sinus cavities; 20 (65 percent) had abnormalities of the ethmoid sinuses; 10 (32 percent) had abnormalities of the frontal sinuses; and 12 (39 percent) had abnormalities of the sphenoid sinuses. Infraorbital air cells were present in 14 subjects (45 percent), and pneumatization of the middle turbinate (concha bullosa) was noted in 11 subjects (35 percent). Also common were engorged turbinates (in 7 subjects) and thickening of the walls of the nasal passages (in 13). After two weeks, the CT studies were repeated in 14 subjects, none of whom received antibiotics. In 11 of these subjects (79 percent) the abnormalities of the infundibula and sinuses had cleared or markedly improved. Nasal-airway resistance was abnormal in 29 (94 percent) and mucosal transport in 19 (61 percent) of the 31 subjects who had CT scans. Rhinovirus was detected in nasal secretions from 24 (27 percent) of 90 subjects. CONCLUSIONS: The common cold is associated with frequent and variable anatomical involvement of the upper airways, including occlusion and abnormalities in the sinus cavities.

Adult↗
PubMed1994

Papaverine-induced mydriasis.

Five cases of ipsilateral pupillary dilatation that developed during local intraarterial infusion of papaverine are reported. All patients were being treated for symptomatic vasospasm secondary to subarachnoid hemorrhage. In each case, the tip of the infusion catheter was positioned in the internal carotid artery in close proximity to the ostium of the ophthalmic artery. Pupillary dilatation in all patients readily resolved after termination of the infusion.

Adult↗
PubMed1994

MR of esthesioneuroblastoma (olfactory neuroblastoma) and appearance after craniofacial resection.

PURPOSE: To analyze the MR characteristics of a series of patients with esthesioneuroblastoma and discuss the typical surgery and its postoperative MR appearance. METHODS: The MR studies of 15 patients with the pathologic diagnosis of esthesioneuroblastoma (also known as olfactory neuroblastoma) were retrospectively reviewed and correlated with CT and surgical findings. The postoperative MR studies of 10 patients who underwent craniofacial resection were also reviewed. RESULTS: In all cases the tumors arose in the superior nasal cavity and extended into the ethmoid cells. In some instances the tumors extended into the other paranasal sinuses, orbits, anterior cranial fossa, and cavernous sinus. The tumors were typically expansile and destructive in their growth patterns. Compared with brain gray matter, the tumors were hypointense on T1-weighted images and isointense to hyperintense on T2-weighted images. Nine tumors were heterogeneous and 6 were homogeneous. Contrast enhancement ranged from mild to marked. MR was useful for characterizing the various tissues and distinguishing fluid in the postoperative nasal cavity. CONCLUSIONS: Esthesioneuroblastoma, although an uncommon tumor, may be suspected in lesions of the superior nasal cavity demonstrating both expansile and destructive growth properties. The MR findings are otherwise nonspecific. MR is the imaging modality of choice for depicting local tumor extension and evaluating for recurrence after craniofacial resection.

Adolescent↗
PubMed1993

Effects of cognitive impairment on the reliability of geriatric assessments in nursing homes.

OBJECTIVE: To explore the relationship between an elderly subject's cognitive status and the reliability of multidimensional assessment data. DESIGN: Survey, with cognitive status as the independent variable and interrater reliability as dependent variable. SETTING: Medicare/Medicaid-certified nursing homes. PARTICIPANTS: 147 residents age 65 or older. MEASUREMENTS: Dual assessments of elderly nursing home residents were performed by nurse assessors using the Health Care Financing Administration's new Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). Assessments were classified on the basis of residents' cognitive status, and levels of disagreement between assessors were analyzed. MAIN RESULTS: Overall assessment reliability, agreement concerning a resident's activities of daily living status, and the reliability of estimates of his or her communication skills and sensory abilities were significantly affected by a resident's cognitive status. The presence of cognitive impairment made these measurements less reliable--especially those related to communication skills, vision, and hearing. CONCLUSIONS: Assessments of residents suffering from cognitive impairment were significantly less reliable than assessments of cognitively intact residents. However, these differences in reliability were not uniform across all assessment domains. When treating the cognitively impaired elderly, clinicians must exercise caution in their reliance on standardized measurements that may be less reliable for this population.

Activities of Daily Living↗
PubMed1993

Reducing the use of physical restraints in nursing homes: will it increase costs?

OBJECTIVES: Reducing the widespread use of physical restraints in nursing homes is a primary goal of the federal nursing home reforms enacted as part of the Omnibus Budget Reconciliation Act of 1987. However, some nursing home operators assert that reducing restraint use could be prohibitively expensive, costing payors perhaps as much as $1 billion annually. We investigated whether nursing home residents free from physical restraint require more care and resources than similar residents who are restrained. METHODS: We examined the major component of nursing home costs--staff time--and its allocation among residents who were physically restrained and those who were not restrained. The multivariate analysis used staff-time-study data on the care of 11,932 nursing home residents in 276 facilities in seven states. RESULTS: The analyses indicate that, when differences in impairment and care needs are controlled for, residents who are physically restrained require more nursing care than other residents. Higher levels of nursing-assistant time were consistently provided to restrained residents. CONCLUSIONS: Residents free of restraints are less costly to care for than restrained residents. The 1987 federal requirements concerning restraint use, which are aimed at improving quality of care and quality of life, can be implemented without engendering a major increase in care costs.

Aged↗
PubMed1992

Nursing home case-mix classification and residents suffering from cognitive impairment: RUG-II and cognition in the Texas case-mix data base.

Case-mix reimbursement systems for nursing home care are now in use or under consideration in over 20 states. Though many in the long-term care field still debate the relative merits of the various systems, those systems based on the Resource Utilization Groups-II (RUG-II) system used in New York seem to be increasingly popular. However, one of the more serious questions raised concerning RUG-like systems is whether they fully acknowledge the role played by cognitive deficits in determining nursing home residents' care needs. The results of this research indicate: 1) that resource provision and cognitive status are correlated, 2) that residents with higher levels of cognitive impairment appear most frequently in RUG-II categories that have higher case-mix weights, 3) that simply adding some measure of cognitive function does not significantly increase the power of these models, and 4) that the RUG-II model predicts the level of care resources provided to the cognitively intact much better than it predicts those provided to residents suffering from relatively severe disorientation. These results imply that such classification systems may create disincentives for the admission of the most cognitively impaired residents and that the care of these individuals, more than others, may be dependent on facility-to-facility variation.

Activities of Daily Living↗
PubMed1992

Treatment of cerebral vasospasm with intra-arterial papaverine.

Cerebral vasospasm continues to be the leading treatable cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. In this preliminary anecdotal series of 12 patients who were candidates for balloon angioplasty, vasospasm was treated instead with intra-arterial papaverine. Eight patients had marked angiographic reversal of the arterial narrowing following papaverine infusion, four of whom showed dramatic reversal of profound neurological deficits. Two patients deteriorated clinically 5 days after the initially successful papaverine infusions. In both, repeat angiography demonstrated severe recurrent vasospasm, which was partially reversed with a second intra-arterial papaverine treatment. Two patients developed focal neurological deficits during papaverine infusion, which resolved spontaneously over several hours after cessation of the intra-arterial infusion. Arterial narrowing in the posterior circulation and middle cerebral artery distribution appeared to be more responsive to papaverine infusion than was spasm in the anterior cerebral arteries. The infusion of 300 mg of papaverine over 1 hour seemed to be an adequate and safe dose to effect these angiographic and clinical improvements.

Adult↗
PubMed1992

Emergent radiologic evaluation of the gunshot wound victim.

The incidence and number of victims of gunshot injury in the United States increases yearly. Rapid acute assessment of these individuals includes radiologic examinations. This article is an overview of current management practices and information relevant to the radiologist who is called upon to evaluate these patients.

Brain Injuries↗
PubMed1992

Classification of civilian craniocerebral gunshot wounds: a multivariate analysis predictive of mortality.

Management of cerebral gunshot injuries has changed considerably since Cushing's (1916) and Matson's (1948) classification schemes, developed during World War I and World War II, respectively. These military injuries are characterized by either very high mass, low-velocity shrapnel wounds or by high muzzle velocity missiles causing extensive destruction of tissue. The preponderance of low muzzle velocity weapons seen in clinical practice and the availability of computed tomographic (CT) evaluation within minutes after presentation has altered the range of prognostic indicators available to the neurosurgeon and the amount of relative importance placed on each factor. Raimondi and Samuelson (1970) noted this difference in wound ballistics and offered a classification scheme based on initial neurologic assessment. No well-defined classification system for civilian craniocerebral gunshot wounds has been proposed that evaluates and integrates clinical, laboratory, and neuroradiologic data. A retrospective study was performed on all 62 civilians with gunshot wounds to the head admitted to the University of Virginia Hospital between December, 1984, and November, 1990. The patient population consists of 86% males and 14% females, with an age range of 10-72 years; 60% self-inflicted wounds and 32% patients who died en route or immediately upon arrival at the hospital. The overall mortality rate was 55% at 1 week postinjury. Although we have demonstrated an association between some previously defined factors and prognosis in civilian injury, such as admission Glasgow Coma Scale (GCS) (p = 0.001) and initial pupillary response (p less than 0.001), we have also defined other significant predictors of outcome including abnormal coagulation states on admission (p less than 0.001) and the neuroradiologic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗