Biomedical subjects
Publications and source records attributed to C R George.
We describe a 44-year-old woman with progressive cervical pain in whom plain films of the cervical spine showed only minor syndesmophyte formation when the patient first presented. However, after 5 weeks, repeat films demonstrated heavy symmetrical calcification of the cervical dorsal root ganglia. A review of the literature did not reveal a previous description of these findings.
A communication course for new hearing aid users, covering explanations of hearing loss and hearing aids, hearing tactics, lipreading and relaxation techniques in three 2 h sessions, was developed. The course was tested on groups of adults fitted with NHS post-aural hearing aids at the Audiology Clinic at the Royal South Hants Hospital. The course content, presentation, length and pace were evaluated by means of a questionnaire given at the end of the last session, and the effects on aid usage, satisfaction and benefit ratings were assessed by pre- and post-fitting questionnaires given to those who attended and to a matched group of control subjects. The course was offered to 41 men and 46 women. The acceptance rate was rather higher for women than for men, but attendance rates were similar for both sexes, men attending 33% and women 36% of the sessions offered. No relationship was observed between age or degree of hearing loss and rates of acceptance and attendance. All those who completed the evaluation questionnaire were satisfied with the content, length, pace and presentation of the course, and considered that it had helped them to understand and cope with their hearing loss. Most (28 out of 31) felt that they would use their aids more as a result of the course. However, their aid usage and ratings of benefit derived from the aids did not differ significantly from those of a matched group of controls who were not offered the course.
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The effect of pre-fitting counselling on the outcome of fittings of NHS behind-the-ear hearing aids to adult first-time users was investigated. Questionnaires and diaries were sent both before and after fitting to 48 subjects who were given pre-fitting counselling and 47 control subjects, all of whom were fitted with standard NHS hearing aids in Southampton or Bath between September 1989 and July 1991. The test and control groups had similar distributions of age, sex and hearing loss. Analysis of the data showed that the counselling had no significant effect on levels of satisfaction, aid usage or benefit; these outcome measures also showed no significant correlation with any of the personal characteristics or attitude factors which were studied.
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Forty of 416 patients with familial adenomatous polyposis were noted to have intra-abdominal desmoid tumors, and a subgroup of 16 were treated with noncytotoxic drug therapy. Drugs used were sulindac (14 patients), sulindac plus tamoxifen (3 patients), indomethacin (4 patients), tamoxifen (4 patients), progesterone (DEPO-PROVERA; Upjohn Co., Kalamazoo, MI) (2 patients), and testolactone (1 patient). Therapy with these drugs for continuous periods of six months or more resulted in three complete and seven partial remissions. When treated patients were compared with untreated patients (n = 12), there were significant benefits for the treated group, both in reduction of desmoid size and in improvement of symptoms, despite the inherent selection bias against this. Sulindac was the only drug used in enough patients to permit independent evaluation of its effect, with one complete and seven partial reductions of tumor size. Some patients had a delayed response to sulindac, with tumor shrinkage occurring after an initial period of tumor enlargement. When using sulindac for the treatment of desmoid tumors, this phenomenon should be considered.
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Ultrasonic techniques have been developed as alternatives to conventional laparoscopic aspiration for oocyte retrieval for in vitro fertilization (IVF). Given the advantages (less risk, lower cost, and greater patient acceptance) of these alternative techniques, it is appropriate to assess their efficacy compared with traditional laparoscopic retrieval. This article examines the recovery rate of oocytes and their subsequent fertilization rate with the use of an ultrasonic endovaginal transducer with fixed needle guide and compares these results with other retrieval methods. Comparisons were made between laparoscopic harvesting (n = 71, group I), ultrasonic transabdominal transvesical (n = 21, group II), and ultrasonic vaginal transducer (n = 76, group III). The data demonstrate comparable success using an ultrasonic endovaginal transducer with fixed needle guide. The authors believe this technique to be the procedure of choice for all routine oocyte retrievals during IVF treatment.
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To evaluate the potential of transscrotal ultrasound and magnetic resonance imaging as noninvasive screening methods we studied 8 boys with acute lymphocytic leukemia before testicular biopsy. Ultrasonic images of the testes were performed in 4 patients, including 2 with negative and 2 with positive biopsies, and all images were interpreted as normal. Magnetic resonance images of the testes also were interpreted as normal in 4 patients, including 2 with negative and 2 with positive biopsies, and they were technically inadequate in the remaining 4. The results suggest that neither transscrotal ultrasonography nor magnetic resonance imaging as currently applied may substitute reliably for testicular biopsy as a screen for occult testicular leukemia.
Most magnetic resonance imaging has used body orthogonal axes with the Z axis placed along the length of the body and the X and Y axes at right angles to the body. This orientation is not optimum for the heart; visualization of sections along the short and long cardiac axes would best define cardiac structural detail and functional status. The new orientation was accomplished by selection of electronic angulation of the magnetic fields for each subject rather than by attempting to approximate the cardiac axes by altering the position of the patient. This technique improved visualization of comparative wall segments, valvular structures, and the true four-chamber view of the heart, and also gave the best visualization of the pericardium. In addition, more accurate estimates of chamber size and myocardial mass can be made from the short-axis orientation, since the sections are orthogonal to the myocardium.
Six patients with documented dissections of the thoracic aorta (two Type A, four Type B) were examined by magnetic resonance (MR) imaging using a 0.6-Tesla superconductive magnet. Cardiac gating was applied in five cases. Correlation was made with CT and angiography. MR imaging demonstrated the dissection in all six cases and accurately differentiated Type A from Type B dissections. Coronal and sagittal MR sections were advantageous in establishing the relationship of the three arch vessels to the dissection. In addition, cardiac-gated MR was useful in demonstrating mural thrombus and in distinguishing the true from the false lumen based on differences in signal intensity resulting from different flow rates. In five cases, the information obtained by MR was equal to or surpassed that obtained by CT. In the one case of a completely thrombosed dissection, the CT scan was more helpful. MR should become an important imaging modality in the evaluation of aortic dissections.