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Biomedical subjects

E M Stafford

Publications and source records attributed to E M Stafford.

17 recordsLinked to original sources
PubMed1996

Detection of human papillomavirus in cervical biopsies of summer camp ROTC cadets with abnormal papanicolaou smears.

STUDY OBJECTIVE: Human papillomavirus (HPV) infections may be the most common sexually transmitted disease (STD) among adolescents and young adults. A strong association exists for certain "high-risk" HPV-type cervical infections and subsequent evolution of cervical cancer and its precursor lesions. The objective of this study was to detect HPV in cervical biopsies of reserve officer training corps (ROTC) cadets attending a regional summer camp who had abnormal screening Papanicolaou (Pap) smears and to better define the spectrum of HPV oncogenic risk types for this population. It was hypothesized that HPV would be detected in the majority of cervical biopsies in keeping with the evolving concept of cervical cancer and its precursors as an STD and the central role of HPV in its development. DESIGN: On arrival for summer military camp training, college women cadets underwent physical examinations that included pelvic examinations for Pap smears. Study participants completed confidential questionnaires after informed consent was obtained. Subjects, who had abnormal Pap smears as defined by reports of atypical squamous cells of undetermined significance (ASCUS) or low- or high-grade squamous intra-epithelial lesions (LGSIL or HGSIL), underwent colposcopic evaluations with cervical biopsies. Subsequently, biopsies were processed for detection of HPV-specific DNA by gel electrophoresis, chemiluminescent oligonucleotide probing, and DNA-RNA hybridization methods after polymerase chain reaction (PCR) amplification. PARTICIPANTS: All female summer camp enrollees presented to the Madigan Army Medical Center Gynecology Clinic for complete physicals before the onset of the training program and were solicited for study inclusion. MAIN OUTCOME MEASURES: All colposcopic biopsy specimens were evaluated for the presence of HPV DNA and subtyped if positive. RESULTS: Representing 42 states, 95% (332) of eligible subjects participated. Mean age was 21.9 years. Racial composition included 70% white, 16% black, 4% Hispanic, 4% Asian, and 6% "other." Eighty-five percent had a history of hetero-sexual activity, with 17.7 years as the mean age at onset. Of the subjects, 12.6% reported a previous diagnosis of a sexually transmitted disease, and 7.8% (26 of 332) had abnormal Pap smears. Of these, colposcopic biopsy results were available for 25 of the 26 abnormal Pap smears. Ninety-six percent (24 of 25) of the colpobiopsies had detectable HPV. Eighty-eight percent (22 of 25) of the subjects with abnormal Pap smears had concurrent abnormal biopsy results. All of these had detectable HPV, confirmed by three different methods, and 29% had dual HPV infection. Sixty percent had "intermediate" or "high-risk" types identified by specific genotyping, 8% had "low-risk" types, and 28% had nontypable HPV. CONCLUSIONS: The data confirm that abnormal Pap smears in this young adult college population are almost always associated with HPV infection, a significant proportion of it being other than low-risk types. The prognostic significance of type-specific cervical HPV infection still needs to be better defined in relation to potential cofactors and host immune response. However, clinicians who provide primary gynecologic care to adolescents and young adults should be aware of the high correlation between abnormal Pap smears and HPV cervical infection and should follow up the patient with the potential risk in mind.

Adolescent↗
PubMed1991

Maximizing the informational content of vectorial data in the electrocardiogram.

Scalar electrocardiograms contain a great deal of vectorial data. The informational content of these data can be maximized by treating each angle as a point on a plane whose distance from the origin is equal to the magnitude of its vector. These points can be resolved into their horizontal and vertical coordinates. The coordinates are linear values and can therefore be subjected to standard statistical methodology.

Adolescent↗
PubMed1990

Cervical intraepithelial neoplasia III in an adolescent with Bowenoid papulosis.

Bowenoid papulosis (BP) is a cutaneous condition of the external genitalia seen primarily in young adults. Evidence supports an etiologic role of human papillomavirus (HPV), particularly type 16. HPV-16 is also associated with an increased risk for cervical intraepithelial neoplasia (CIN) and invasive carcinoma. A 17-year-old female, referred to the adolescent dysplasia clinic with a diagnosis of condyloma acuminatum, was presented. She had multiple smooth, shiny, brown 3- to 4-mm papules on the external genitalia. Biopsy confirmed BP. Colposcopic examination of the cervix and biopsy showed CIN III. The patient's sexual partner was examined colposcopically, and no suspicious lesions were seen. The patient underwent laser vaporization of her external genital and cervical lesions. At the time of treatment, some of the initial BP lesions had spontaneously regressed. This case highlights the need to evaluate females with BP for possible CIN, to examine sexual partners, and to use ablative therapy, as there is the potential of malignant progression in BP.

Adolescent↗
PubMed1989

Sexual maturity rating: a marker for effects of pubertal maturation on the adolescent electrocardiogram.

The heart is known to participate in the adolescent growth spurt. A peak increase in transverse diameter coincides with peak height velocity during pubertal maturation. The effects of maturation on the adolescent ECG were explored using sexual maturity rating (SMR) as a marker. ECGs were obtained from 751 patients 8 to 20 years of age seen for routine physical examinations. A total of 33 standard ECG measures were analyzed, with subjects separated by sex and SMR. Different trends were seen in boys and girls during the course of maturation for the majority of R and S wave amplitude measurements. Lower mean amplitudes were seen consistently in more mature (SMR 4 and 5) girls than less mature girls and all boys. The clinical implication of these findings is illustrated by analysis of the sum of RV5 and SV2, one of the criteria for left ventricular hypertrophy, by sex and SMR. No significant difference in the sum is noted for boys across five SMR groups. Girls, in contrast, show a steady decrease in the sum with advancing maturation. These trends are not as clearly shown when subjects are grouped by broad chronologic age ranges, as had been the practice in developing current adolescent ECG tables. These findings suggest that development of standard ECG tables in which SMR and sex have been taken into account might enhance interpretation during adolescence.

Adolescent↗
PubMed1988

The relationship between sexual maturity rating, age, and increased blood pressure in adolescents.

Blood pressure values are known to vary with age and body size. The effect of sexual maturity was explored in 746 patients in an adolescent clinic. Systolic blood pressure for boys and girls showed an increase with a change from Tanner stage 2 to 3. Diastolic blood pressure did not increase. Both systolic and diastolic blood pressures showed a weight effect that was generally maintained within the Tanner stages. The gradual increase in blood pressure for large groups of adolescents would appear to be the result of the aggregate increase in size (weight) resulting from the asynchronous growth spurts of individuals studied. Consequently, those individuals with a strikingly early or late onset of maturation may have erroneous interpretations of their blood pressure. As biologic outliers, the borderline hypertensive who matures early may be overidentified, while the late maturer might go unrecognized.

Adolescent↗
PubMed1987

Gastroesophageal polyp diagnosed in an adolescent presenting with epigastric pain.

A gastroesophageal polyp is a rare finding. The case of an adolescent male presenting with epigastric pain and such a polyp is described. These polyps are usually described in the clinical setting of gastroesophageal reflux and esophagitis. Polyps can be identified radiographically as a characteristic filling defect at the gastroesophageal junction. Endoscopy should be used to confirm the diagnosis. Polypectomy is recommended when malignancy is suspected or where there is evidence suggesting that the polyp is causing symptoms.

Adolescent↗
PubMed1986

Relationship between occupational therapy student learning styles and clinic performance.

Scores from the Learning Style Inventory (LSI), Your Style of Learning and Thinking (SOLAT), and Fieldwork Performance Reports (FWPRs) were used to assess the relationship between learning styles and clinic performance of 33 occupational therapy students who graduated from the University of Puget Sound in May 1983. The LSI was administered during the first semester of professional studies. The SOLAT was administered during the second fieldwork experience. There were significant correlations between scores from both learning style instruments and components of the Physical Disabilities Fieldwork Performance Report (PDFWPR) and Mental Health Fieldwork Performance Report (MHFWPR) scores. Results indicate that a logical, sequential cognitive style enhanced PDFWPR scores, but negatively affected some MHFWPR scores. A preference for active experimentation contributed to both PDFWPR and MHFWPR scores. Regression analysis identified the LSI Active-Reflective score as the best predictor of the PDFWPR total. Results suggest further research to assess learning styles as predictors of clinic performance and guides for curriculum design.

Clinical Competence↗
PubMedDate not supplied

Inappropriate antidiuretic hormone in children with viral meningitis.

Urinary excretion rates of antidiuretic hormone were determined by radioimmunoassay in children with bacterial (6) and viral (11) meningitis, and in children with other febrile illnesses (7). These values were compared to normal data obtained from 50 healthy, normally hydrated children ranging in age from 1 week to 9 years. Plasma sodium concentrations were measured in the sick children; urine osmolality and creatinine concentrations were measured in all children. Upon admission, all children with bacterial meningitis and 64% of those with viral meningitis had urinary antidiuretic hormone excretion rates greater than 2 S.D. above values obtained from age-matched controls. Fifty-seven percent of children with other febrile illnesses had similarly elevated antidiuretic hormone values; however, only in the bacterial and viral meningitis groups were antidiuretic hormone excretion rates inappropriate because they occurred when serum sodium concentrations were found to be normal or low normal (i.e., 136 +/- 2 mEq/L and 137 +/- 1 mEq/L, respectively). The average serum sodium in the group with other febrile illnesses was higher (146 +/- 5 mEq/L; p less than 0.05) and could represent an appropriate stimulus for antidiuretic hormone release. In spite of high levels of antidiuretic hormone, most viral meningitis patients did not concentrate their urine, probably because all except 2 were younger than 2 months of age. We conclude that viral meningitis, like bacterial meningitis, frequently is associated with inappropriate antidiuretic hormone secretion; however, most children with viral meningitis may be protected from developing hyponatremia because of their inability to concentrate their urine.

Child↗