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Biomedical subjects

E H Smith

Publications and source records attributed to E H Smith.

At least 19 recordsLinked to original sources
PubMed1991

A double-blind, multicenter comparison of 0.05% halobetasol propionate ointment and 0.05% clobetasol propionate ointment in patients with chronic, localized plaque psoriasis.

In a double-blind, parallel-group, multicenter trial in 134 patients with severe, localized, plaque psoriasis, the success rate (described as "healed" or "marked improvement") at the end of the study was 96% in the halobetasol propionate group and 91% in the clobetasol propionate group. A significantly larger proportion of patients treated with halobetasol had no disease or mild disease after 14 days compared with those treated with clobetasol (86% versus 70%, p = 0.023). Healing within 24 days of starting treatment was noted in 69% and 56% of patients treated with halobetasol and clobetasol, respectively. Adverse effects were reported in a smaller percentage of patients treated with halobetasol propionate ointment than in those treated with clobetasol propionate ointment (7% versus 12%). Cosmetic acceptability and ease of application were recorded as "very good" in a larger percentage of patients treated with halobetasol propionate ointment than in the group treated with clobetasol propionate (90% versus 80%).

Adult↗
PubMed1991

Complications of percutaneous abdominal fine-needle biopsy. Review.

To determine whether the increasing use of percutaneous fine-needle biopsy of abdominal lesions is associated with an increase in serious complications, the author updated a literature search and evaluated a questionnaire (distributed among selected hospitals in the United States in 1986 and 1987) that followed up a questionnaire distributed in 1983. The updated literature review revealed a total of 24 deaths and 20 needle tract seedings. The updated questionnaire revealed five deaths after 16,381 biopsies (0.031%), whereas the previous questionnaire had shown four deaths after 63,108 biopsies (0.006%). Two similar European questionnaires revealed mortality rates of 0.008% and 0.018%, respectively. Of the total of 33 deaths, 21 involved biopsies of liver lesions; six involved pancreatic biopsies. Seventeen of the 21 deaths after liver biopsies were secondary to hemorrhage; five of the six deaths after pancreatic biopsies were due to pancreatitis. Of the 23 instances of needle tract seeding, 10 occurred after biopsies of pancreatic malignancies. The frequencies of needle tract seeding in the four questionnaires were 0.005%, 0.006%, 0.003%, and 0.009%, respectively. Although infrequent, serious complications may be associated with this procedure. The author makes suggestions that may help minimize them.

Abdominal Neoplasms↗
PubMed1988

Beta-adrenoceptors on duodenal mucosal cells mediate venous serotonin release.

We have previously documented predominant intraluminal release of serotonin (5-HT) following activation of muscarinic receptors on enterochromaffin cells. Gronstad et al. reported that portal venous release of 5-HT in response to vagal stimulation was mediated by beta-adrenergic receptors. The purpose of this study was to determine whether 5-HT release induced by the beta-adrenergic agonist, isoproterenol, is mediated by enteric nerves or is a direct action at the enterochromaffin cell level. We mounted rabbit duodenal mucosal sheets stripped of muscularis in modified Ussing chambers and measured release of 5-HT in response to 10(-5) M isoproterenol, in the presence and absence of the neural conduction blocker tetrotoxin, 10(-6) M. Serotonin was measured in the buffer bathing the mucosal and submucosal surfaces by HPLC. In the presence of isoproterenol, total (mucosal and submucosal) 5-HT release (21.0 +/- 4.9 ng/cm2/45 min) was significantly (P less than 0.05) greater than that in untreated controls (7.8 +/- 2.7 ng/cm2/45 min); release was predominantly toward the submucosal surface. In the presence of tetrodotoxin alone, net 5-HT release was significantly (P less than 0.05) increased to 12.8 +/- 2.8 ng/cm2/45 min. In tetrodotoxin-treated mucosa, isoproterenol increased 5-HT release to 28.6 +/- 5.3 ng/cm2/45 min which was significantly greater (P less than 0.05) than that with tetrodotoxin alone. Since 5-HT release was increased even in the presence of neural blockade, these results suggest that activation of beta-adrenergic receptors on or near enterochromaffin cells induces release of 5-HT predominantly toward the submucosal surface.

Animals↗
PubMed1988

CT of the pancreas with a fat-density oral contrast regimen.

Visualization of the head of the pancreas by CT was prospectively evaluated in two groups of 100 patients who did not have pancreatic disease. Patients were given either a fat-density oral contrast material (12.5% corn-oil emulsion and metoclopramide) or a conventional high-density oral contrast material (barium suspension or iodinated solution). There was no statistically significant difference in the subjects' tolerance to the two regimens. There was, however, a significant improvement in ability to distinguish the head of the pancreas from the duodenal C-loop when the fat-density contrast material was given. When pancreaticoduodenal discrimination was graded, patients given corn-oil emulsion and metoclopramide received an average score of 0.94, whereas those given the high-density agent received an average score of 0.74, with 1.00 being the highest possible score (p less than .005). These data suggest that for routine CT evaluation of the head of the pancreas, a combination of corn-oil emulsion and metoclopramide may be superior to the conventional high-density oral contrast agents given without metoclopramide.

Administration, Oral↗
PubMed1987

Computed tomography of life-threatening complications of abdominal aortic aneurysm. The disrupted aortic wall.

A localized disruption of the conspicuity of the wall of the aorta was noted on intravenous contrast-enhanced computed tomography (CT) scans of ten patients with ruptured abdominal aortic aneurysm (n = 6) or aortoenteric fistula (n = 4). Subsequently, we reviewed 84 scans of patients with uncomplicated aneurysm (n = 70) or aneurysm graft repair (n = 14) to determine if a disrupted wall has diagnostic implications. In this control group, the wall of the aneurysm was conspicuous throughout in 95% of 64 patients who received iodinated contrast material intravenously and in 55% of 20 patients who did not. In the proper clinical setting, CT scans performed with intravenous administration of iodinated contrast material can provide direct evidence of disruption of the wall of an abdominal aortic aneurysm. In selected cases, this may be important for the diagnosis of rupture. Disrupted conspicuity of the wall, in combination with effacement of the fat plane between an aneurysm and the juxtaposed intestine, increases the accuracy of CT for the diagnosis of aortoenteric fistula.

Aorta, Abdominal↗
PubMed1987

Fat-density oral contrast agent for abdominal CT.

To overcome the problem of inadequate mixing of gastrointestinal (GI) tract contents with conventional high-density oral contrast agents in abdominal computed tomography (CT), a flavored 12.5% corn oil emulsion (COE) was tested as an oral contrast agent in 62 patients. The results were compared with those obtained from 105 patients who received high-density oral contrast agents. A simple patient preparation regimen for the COE was developed, which appears to be reasonably well tolerated by the patients and yields diagnostic studies comparable to those obtained with conventional agents. Use of the COE resulted in consistent discrimination of the GI tract and depiction of the GI wall. Preliminary data suggest that it may be particularly useful for CT evaluation of the stomach, duodenum, and pancreas; in patients suspected of having solid tumors; and in thin people.

Barium Sulfate↗
PubMed1987

Clinicians' appraisal of sonography.

The perceived efficacy of sonography in making diagnostic and management decisions in clinical practice was determined through a questionnaire survey of physicians who had recently referred patients to a university radiology department. Of 2,178 questionnaires sent, 1,611 were returned (74%). Sensitivity and specificity of sonography, corrected for verification bias, were 72% and 84%. Referring physicians considered the studies to be of value in arriving at the final diagnosis and in the clinical management of patients in approximately two-thirds of the cases. Results were considered of no value and misleading in 4% of the cases. Sonography was more accurate and was reported to be valuable by approximately 10% more physicians when a specific indication for an examination could be identified rather than when indications were vague and when sonographic findings were abnormal rather than normal (P less than .005). In general, sonography was of equal value to both specialists and nonspecialists. The results of this study suggest that sonography is, and is perceived by clinicians to be, an accurate and valuable clinical diagnostic modality.

Attitude of Health Personnel↗
PubMed1986

Imaging of the bowel wall. Computed tomography and fat density oral-contrast agent in an animal model.

In this study, we reassessed the problems encountered in computed tomographic (CT) examinations performed with conventional bowel preparations, and developed a fat density oral contrast in dogs. Conventional high-density agents, water, fat (negative) density, and air were administered using a nasogastric tube to eight dogs (25 separate CT scans). Optimal and consistent identification of the gastrointestinal (GI) tract and mural visualization were achieved with 400 ml of 12.5% to 50% corn oil emulsions administered in four hourly divided doses. Mild diarrhea was observed with the 50% concentration only, but no untoward effect was noted clinically with 25% and 12.5% emulsions. Mixing the negative (fat) density oral contrast with the GI contents produced conditions optimal for high-CT contrast resolution of the GI wall. Standard intravenous administration of iodinated contrast agent enhanced mural visualization and, in conjunction with dynamic scanning, time density curves. This suggests that vascular perfusion could be portrayed. This animal model may be used for the experimental evaluation of a number of GI abnormalities, including ischemic, neoplastic, and inflammatory conditions.

Administration, Oral↗
PubMed1986

Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation.

Despite the recent advances in hepatobiliary imaging, the diagnosis of chronic acalculous gallbladder disease remains difficult. A retrospective study was undertaken to assess the value of a multiimaging approach in detecting chronic acalculous gallbladder disease and in predicting which patients would obtain symptomatic relief after cholecystectomy. Of 199 patients with chronic cholecystitis, 26 (13%) had no gallstones. Of these 26, only 17 (65%) had symptoms related to chronic cholecystitis; in the remainder, the histologic diagnosis was made incidentally. After cholecystectomy, 13 (76%) of the 17 symptomatic patients obtained long-term symptomatic relief, while in four, the symptoms recurred. Among patients with histologic changes of chronic cholecystitis, biliary scintigraphy was the most sensitive technique (sensitivity, 89%). The sensitivity of sonography and oral cholecystography was 61.5% and 66%, respectively. However, for identifying symptomatic patients who may obtain long-term symptomatic relief after cholecystectomy, the accuracy of sonography, oral cholecystography, and biliary scintigraphy was 82%, 86%, and 38%, respectively. When two tests were in agreement the accuracy was 88%. For chronic acalculous cholecystitis, more than one study must be performed in order to make the correct diagnosis and to predict good results from cholecystectomy.

Adult↗
PubMed1986

Bile-duct dilatation after laparotomy: a potential effect of intestinal hypomotility.

Dilatation of unobstructed extrahepatic bile ducts was observed in patients with conditions associated with intestinal hypomotility. For further investigation of this association, a prospective study was undertaken in which the common hepatic duct was measured in 15 patients before and 1 day after laparotomy, when all patients had postoperative paralytic ileus. A statistically significant (p less than 0.01) increase in the mean diameter of the hepatic duct was observed postoperatively. When compared with the preoperative measurement, the mean diameter of the duct almost doubled, from 3.3 to 5.9 mm. This phenomenon may be due to persistent contraction of the sphincter of Oddi that occurs when intestinal hypomotility eliminates the stimuli for cholecystokinin release.

Adult↗
PubMed1985

Sarcoid dactylitis in black South African patients.

Six black South Africans with sarcoid dactylitis are described. By the term sarcoid dactylitis we mean sarcoid involvement of the bone and soft tissue of the fingers. Three of the six patients developed dactylitis during the course of chronic sarcoid. These patients had multisystem disease. In all three patients dactylitis developed after the diagnosis of sarcoid was established. However, in the other three patients dactylitis was the presenting feature of sarcoidosis, and none of these patients had evidence of chronic fibrotic sarcoid elsewhere. This finding is at variance with the observation that bony sarcoid is always a feature of chronic, poor prognosis, fibrotic sarcoid of all organ systems; these patients may form a sub-group with bony involvement and good prognosis. The significance, however, of this latter localized presentation of sarcoid is that clinically and histologically it is easily confused with tuberculoid leprosy and has been misdiagnosed.

Adolescent↗
PubMed1984

Pyoderma gangrenosum and ulcerative colitis in black South Africans. Case reports.

Two patients with pyoderma gangrenosum and ulcerative colitis are described. To our knowledge this is the first report of such an association in Blacks. The unusual vesicopustular form of pyoderma gangrenosum was well demonstrated by one patient who also responded remarkably to clofazimine. The associations, pathological findings and therapy are briefly reviewed. Colectomy may ameliorate the skin lesions when conventional therapy is unsuccessful.

Adolescent↗
PubMed1983

Pityriasis rotunda. A cutaneous sign of malignant disease in two patients.

The term pityriasis rotunda refers to strikingly circular scaly lesions, with the histologic appearance of ichthyosis vulgaris. Pityriasis rotunda has been described in the Japanese, South African blacks, and West Indian blacks. The condition occurs only in association with certain serious systemic illnesses, usually tuberculosis, or malignant neoplasms or less severe diseases of the female genital tract (eg, fibroids, ovarian cyst). We describe two South African blacks with pityriasis rotunda and neoplasms. The cutaneous lesions cleared when the primary neoplasm was treated.

Black People↗
PubMed1983

Diagnosis of peritoneal mesothelioma: computed tomography, sonography, and fine-needle aspiration biopsy.

The diagnosis of peritoneal mesothelioma was made prospectively and noninvasively in four patients with the use of sonography, computed tomography, and sonographically guided fine-needle aspiration biopsy. The imaging methods revealed information similar to the operative findings, with clear superiority of computed tomography over sonography. These noninvasive methods may be used as screening tools, especially among groups or in regional areas with a high risk for asbestos exposure. The findings included soft-tissue masses with invariable involvement of the omentum; small intraperitoneal nodules; thickened peritoneum, mesentery, and bowel wall; pleural plaques; and usually minimal, if any, ascites. Since the differential diagnosis from peritoneal carcinomatosis may be difficult, sonographically (or CT) guided aspiration biopsy is needed to produce diagnostic cytologic specimens. The use of this type of biopsy should obviate surgical exploration.

Aged↗
PubMed1982

Ultrasound in the diagnosis of a palpable abdominal mass. A prospective study of 107 patients.

In 107 consecutive patients referred to the ultrasound laboratory for investigation of a palpable abdominal mass, the examination was performed without knowledge of clinical history, laboratory findings, or the results of other examinations. In 101 of the patients the correct diagnosis was subsequently verified, and 29 different ultrasonic diagnoses were reached. In 98 (97%) of the patients the ultrasonic diagnoses were correct. Two uterine leiomyomas were erroneously diagnosed as ovarian in origin, and a massive adrenal carcinoma was misdiagnosed as a hepatic tumor. It is suggested that ultrasonic scanning is the method of choice in evaluating patients with a palpable abdominal mass.

Abdominal Neoplasms↗
PubMed1982

Pulmonary complications of chemotherapy regimens containing bleomycin.

Twenty patients with pulmonary complications associated with combination chemotherapy regimens containing bleomycin were studied to determine common patterns of pulmonary radiographic abnormalities. All patients were receiving bleomycin on one of two different regimens of combination chemotherapy. Ten patients with non-Hodgkin lymphoma received a relatively low dose (22-64 mg total) and 10 patients with testicular cancer received a higher dose (360 mg total). The high-dose group showed subclinical radiographic lung toxicity changes in eight (80%) patients during and after therapy. Chronic pulmonary abnormalities were seen in nine (90%) patients in the high-dose group but in only three (30%) patients in the low-dose group. These was no significant difference in the pattern and distribution of lung infiltrates in these two groups. Infiltrates involving mainly the costophrenic triangle were seen in 18 (90%) patients; in six (33%) of these the changes were confined to the costophrenic triangles bilaterally and nearly symmetrically. Five (25%) patients had infiltrates at the periphery of the lungs. Elevation of the diaphragm was seen in 16 (80%) patients. A pleural reaction without gross effusion was seen in nine (45%) patients, of whom five (55%) demonstrated thickening of the interlobar fissures. Chronic lung changes were mostly confined to the bases in the form of failure of reexpansion of the costophrenic triangle (55%), persistent elevation of the diaphragm (35%), and a reticular meshwork of fibrosis at the costophrenic triangles (25%). Minimal lung disease was manifest as ground glass appearance at the lung bases and as fine, linear or reticulonodular densities that involved the costophrenic triangles.

Adult↗