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Biomedical subjects

D Willis

Publications and source records attributed to D Willis.

At least 19 recordsLinked to original sources
PubMed1992

Cervicovaginal cytology in carcinosarcoma [malignant mixed mullerian (mesodermal) tumor] of the uterus.

We examined the cervicovaginal cytology (PAP) findings in a series of 21 endometrial and 2 cervical carcinosarcomas (CS) [malignant mixed mullerian (mesodermal) tumors] (MMMT). Initial cytology diagnosis was positive for cancer in 14 of 23 cases (sensitivity of 61%); however, CS was correctly identified only 2 times. The remaining 12 cancer diagnoses were carcinomas: 10 adenocarcinomas (4 endometrial, 1 cervical, and 5 adenocarcinomas not otherwise specified), 1 squamous carcinoma, and 1 poorly differentiated carcinoma. Seventeen smears were available for review, all 8 false negative, one unsatisfactory, and 8 of 14 true positive smears. One false negative smear showed rare clusters diagnostic of adenocarcinoma. The remaining 7 false negative smears showed 3 high grade squamous dysplasias (two with additional findings: one showed atypical spindle cells and the other showed endometrial stromal cells), 2 extensive repair changes, and 2 negatives. The unsatisfactory smear showed atypical spindle cells. Review of the 8 true positive smears confirmed malignant spindle cells in the two cases originally identified as CS by cytology and in 3 other cases originally identified as adenocarcinoma. Of 9 smears positive for cancer available for review, 4 showed only carcinoma cells. PAP positive for cancer was associated with high stage at presentation (P less than .025) and recurrent disease (P less than .001) (even among stage I or II patients, P less than .025). PAP positive for cancer showed no association with depth of myometrial invasion, size, grade, or histologic type of carcinosarcoma. The results of this study demonstrate the importance of consultative cytology reporting in which recommendations for appropriate biopsy are included in the report.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Inhibitory effects of insulin-like growth factor-binding proteins on steroidogenesis by human granulosa cells in culture.

The effects of insulin-like growth factor-binding proteins (IGFBPs) 1 and 3 on steroidogenesis by human granulosa cells has been examined. Both IGFBP-1 and IGFBP-3 produced a dose-related inhibition of IGF-I-stimulated oestradiol accumulation in granulosa cell-conditioned medium with complete reversal of the effects of IGF-I in the presence of a molar excess of binding protein. IGFBPs 1 and 3 also exerted a small (25-40%) but significant and consistent inhibition of oestradiol secretion in response to follicle-stimulating hormone (FSH) alone. The progesterone response to IGF-I was inhibited by IGFBPs 1 and 3 but there was no effect on FSH-stimulated progesterone production. These data support the concept of a physiologically important intraovarian IGF system in the human ovary and demonstrate an unequivocally inhibitory effect of IGFBPs 1 and 3 on IGF-I-stimulated granulosa cell steroidogenesis.

Carrier Proteins↗
PubMed1992

Prostaglandin E2 gel induction of patients with a prior low transverse cesarean section.

To determine safety and efficacy of induction with prostaglandin E2 gel, we compared the outcome of 25 patients (study group) with an unfavorable cervix, a medical indication for delivery, and one prior low cervical transverse cesarean section to 56 patients (comparison group) with one prior low cervical transverse cesarean section and spontaneous labor. We placed 1 mg of prostaglandin E2 in gel intracervically in the 25 study patients. Common indications for delivery were: diabetes, post dates, and preeclampsia. Although most labor and delivery variables were similar, the study group had a longer mean latent phase (14.2 +/- 13.8 versus 7.3 +/- 3.7 hours: p less than 0.002), but had a shorter mean length of active phase (4.0 +/- 3.5 versus 5.7 +/- 3.0 hours; p less than 0.02). None of the patients in either group had a dehiscence of the uterine scar, nor rupture of the uterus. Both groups had a similar cesarean section rate. Since from the few reported, nonrandomized studies it appears that prostaglandin E2 gel use in patients with a prior low cervical transverse cesarean section may be useful and relatively safe, it may be time to attempt randomized trials of prostaglandin E2 gel versus oxytocin for induction of patients with a prior low cervical transverse cesarean section, unfavorable cervix, and a medical indication for delivery.

Adult↗
PubMed1991

Patient attitudes toward testing for maternal serum alpha-fetoprotein values when results are false-positive or true-negative.

We investigated the attitudes toward the maternal serum alpha-fetoprotein (MSAFP) test of patients whose results from MSAFP testing were either false-positive or true-negative. Forty-six women who had previous false-positive results from MSAFP testing and 46 who had previous true-negative values participated. Patients were matched for age and socioeconomic status, and all were delivered of normal neonates. A significantly larger number of patients in the group with false-positive results believed they had not understood the MSAFP test than in the group with true-negative results (19.6% vs 0%). Significantly more women in the "false-positive" group felt that the test caused anxiety than in the "true-negative" group (65.2% vs 17.4%). Fewer women in the false-positive group than in the true-negative group said they would have MSAFP testing in a subsequent pregnancy (58.7% vs 91.3%). Further, the women in the false-positive group were less likely than those in the true-negative group to recommend MSAFP testing to a friend (52.1% vs 80.4%). In patients whose results were false-positive, there was a significant relationship between the patient's perception of understanding the MSAFP test and her attitude toward MSAFP testing.

Adult↗
PubMed1991

Intracranial astrocytoma: pathology, diagnosis and clinical presentation.

Approximately 15,000 deaths a year occur in the United States from brain tumors. Astrocytomas, the most common primary tumor of the central nervous system, develop from astrocytes, the neuroglial support cell. Normal astrocytes can undergo anaplasia for unknown reasons and form brain tumors. Astrocytomas are graded from I to IV. As normal brain tissue is displaced by tumor cells, varying signs and symptoms develop, depending on tumor site and size. The goal of surgery, radiation, chemotherapy or a combination of these treatments is to decrease tumor size and improve quality of life and survival time. This article addresses astrocyte cell development, classification of astrocytomas, theories of tumor development, signs and symptoms of astrocytoma, diagnosis and treatment of the astrocytoma. The role of the nurse is explored and two case histories are presented.

Adult↗
PubMed1991

Lyme disease.

Lyme disease, also known as Lyme borreliosis, is at present the most common arthropod-borne infectious disease in Europe and the United States. It is caused by the bacterial spirochete Borrelia burgdorferi and transmitted to the human primarily in the spring, summer and early fall by the tick Ixodes dammini or deer tick. Signs and symptoms of infection are many and misdiagnosis often occurs. If not treated with antibiotics in early stages neurological complications can occur. Health care providers must have a thorough knowledge of the disease so they are able to recognize signs and symptoms. Health care personnel are the key to education of the public and their peers regarding prevention, recognition and treatment of Lyme disease.

Education, Nursing, Continuing↗
PubMed1990

Transcatheter arterial embolization of cerebral arteriovenous malformations.

An arteriovenous malformation (AVM) is a tangled mass of arteries and veins. These abnormal dilated vessels shunt blood away from normal brain tissue, resulting in adjacent tissue damage. In the past surgical removal of an AVM was often complicated by hemorrhage. In some cases the location or size of an AVM made it unresectable. The risks of surgical removal have led to the development of alternative approaches for the treatment of AVMs, such as transcatheter arterial embolization therapy. A variety of substances can be introduced via a catheter to occlude the abnormal vessels and obliterate the AVM or to decrease size to ease surgical management. This article discusses patient selection for embolization therapy, the materials and methods used and related nursing care and patient education. A case history is presented.

Embolization, Therapeutic↗
PubMed1990

The effect of gestational age at birth on somatosensory-evoked potentials performed at term.

Multimodality-evoked potentials are widely used in newborns to assess the maturation and integrity of the sensory pathways. Reliable normative data are needed to maximize the utility of this technique as a diagnostic and research tool. Several electrophysiologic studies on the maturational changes of the auditory brain-stem response have demonstrated that latency measurements decrease as a function of increasing conceptional age. However, maturational studies of the somatosensory-evoked potential, particularly in low-risk premature infants, are limited. The existing evoked potential literature in healthy newborns proposes that maturation of the central nervous system occurs at a predictable rate, irrespective of a given gestational age at birth. Behavioral studies of premature infants suggest that neurologic development may be altered by early extrauterine exposure. The purpose of this study was to determine whether brain-stem auditory- or somatosensory-evoked potential conduction times were comparable in premature and full-term infants matched for conceptional age. The results of this study suggest that myelination is determined by conceptional age, independent of premature birth.

Brain Stem↗
PubMed1990

Linear basal cell nevus.

We report a case of linear basal cell nervus occurring on the thigh of a forty-five-year-old woman. In this lesion, the characteristic comedones were absent. Linear basal cell nevus is a rare, benign condition that must be differentiated from both basal cell nevus syndrome and linear basal cell carcinoma, either of which can be locally aggressive.

Basal Cell Nevus Syndrome↗
PubMed1989

A fatal attraction: cocaine related subarachnoid hemorrhage.

An alarming number of people use cocaine, a drug surrounded with myths and misconceptions. Cocaine use is associated with many medical and psychiatric problems. It is now believed cocaine use may lead to subarachnoid hemorrhage. Cocaine stimulates the release of various neurotransmitters in the brain as well as blocks their uptake, causing a temporary surge in systolic blood pressure. The constant assault on the vessels from continuous cocaine use weakens them causing hemorrhage or possibly creates an aneurysm. This article explains how cocaine affects the blood vessels and neurotransmitters of the brain, reviews two case histories in which cocaine may have contributed to aneurysmal formation and subarachnoid hemorrhage and discusses nursing implications of cocaine related subarachnoid hemorrhage.

Adult↗
PubMed1988

Granuloma inguinale (donovanosis) in women.

A ten-year review (1973-1983) revealed 13 cases of documented granuloma inguinale at Grady Memorial Hospital, Atlanta. The patients' ages ranged from 17 to 77, with the majority in their early 20s. The initial presentation of granuloma inguinale included large, fungating labial ulcers, labial swelling, vaginal discharge, rectovaginal fistulae and hematuria. Common presumptive diagnoses included carcinoma, herpes, syphilis and granuloma inguinale. The final diagnosis was made with cytology and/or tissue examination with the help of special stains to demonstrate the causative organism, Calymmatobacterium granulomatis. Granuloma inguinale is rare and difficult to diagnose, but with physician awareness, cytology and biopsy, it should not be missed.

Adolescent↗
PubMed1987

Evaluation of latex-based heterophile antibody assay for diagnosis of acute infectious mononucleosis.

The diagnosis of an acute episode of infectious mononucleosis (IM) is made on the basis of clinical symptoms and serological evidence for development of heterophile antibodies. In an effort to obtain a very sensitive and specific assay for diagnosis of IM, we have developed MERISTAR:IM. The MERISTAR assay uses latex beads coated with purified bovine heterophile antigen. We compared the sensitivity and specificity and performance characteristics of the latex-based test to those of the commercially available erythrocyte-based Monospot test with serum samples from 363 suspected-IM patients and controls. A total of 28 samples from patients with confirmed IM were positive with the MERISTAR assay, while only 23 of the samples were positive with the Monospot assay. The two assays had equal specificity, as each test gave two false-positive results. In the technical performance of the assay, the MERISTAR assay was simpler and faster to perform than the Monospot assay.

Acute Disease↗
PubMed1986

Intracranial interstitial radiation.

Primary malignant brain tumors are fatal, with 90% of patients having these tumors dying within two years following diagnosis. Cranial interstitial radiation therapy, a technique under investigation to control these tumors, involves implantation of radioactive iodine 125 seeds into the tumor bed by stereotaxic technique. The interstitial radiation technique, monitoring of radiation, and nursing care of patients are discussed. Case histories are presented, along with discussion of results attained using this therapy, and its future.

Adult↗
PubMed1979

Sequelae of caffeine treatment in preterm infants with apnea.

Growth, neurologic, and ophthalmologic assessments were done in 21 low-birth-weight infants given caffeine for neonatal apnea and in 21 matched control infants. Caffeine significantly decreased the need for and the duration of mechanical ventilation. No difference in growth and development was noted between the control and caffeine-treated infants. A high incidence of cicatricial retrolental fibroplasia was observed in both control (10/21) and caffeine-treated infants (7/18).

Apnea↗