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Biomedical subjects

G Ellis

Publications and source records attributed to G Ellis.

At least 37 records · Page 2Linked to original sources
PubMed1996

Primary hyperparathyroidism in a paediatric hospital.

We retrospectively reviewed the presentation and management of children with primary hyperparathyroidism (PHPT) from 1973 to 1995 at a paediatric tertiary-care centre. There were 11 patients (6 females), aged 12.3-17.7 years at presentation, with sporadic PHPT confirmed by histopathology (single adenoma). Presentation consisted of renal colic, or non-specific gastrointestinal, musculoskeletal or neurological symptoms. Misdiagnosis was common until hypercalcaemia was identified, 0.5-24 months after onset of symptoms (mean 7.7 months). All patients had hypercalcaemia and low-normal serum phosphate. The parathyroid hormone (PTH) radioimmunoassay used before 1986 was elevated in 1/4 patients; the intact PTH assay used after 1986 was elevated in 7/7 patients. At presentation, six had end-organ damage: band keratopathy, renal lesions, and/or bone disease. Preoperative localization was accurate in 0/4 patients diagnosed before 1986, but 5/7 patients diagnosed after 1986: three by ultrasound or sestamibi scan alone, and two by ultrasound and technetium scan. Surgical outcome was not dependent upon the accuracy of pre-operative localization. PHPT is rare in children but usually associated with end-organ damage, presumably due to delayed diagnosis. It should be considered in the differential diagnosis of unexplained non-specific complaints. The intact PTH assay greatly assists pre-operative diagnosis. The usefulness of pre-operative localization requires further research.

Adolescent↗
PubMed1996

Serum prostate-specific antigen measured in children from birth to age 18 years.

We measured prostate-specific antigen (PSA) in serum from 94 cord- blood samples, from 44 newborns, and from 330 children up to age 18 years, using a highly sensitive "third generation" PSA assay on the IMMULITE (Diagnostic Products Corp.) analyzer. The serum was that remaining after cross-matching for blood transfusion. Most children were hospitalized for special care or surgery. We found detectable concentrations of PSA (> or = 0.003 micrograms/L) in many cord sera and in sera from both male and female neonates. PSA was more frequently detectable in cord and newborn sera from males than from females, but there was considerable overlap in values between the sexes, negating any possible usefulness of PSA for assigning male gender to newborns with ambiguous genitalia. PSA decreased to undetectable concentrations in most prepubertal males and females but became detectable around the age of puberty in males. We speculate that the presence of detectable PSA in cord and newborn sera results from androgenic stimulation of prostatic tissue in males or from stimulation of breast or other tissue by prolactin or progesterone in females.

Adolescent↗
PubMed1996

Chronic paronychia and onycholysis: a thirteen-year experience.

We report here on two retrospective studies conducted between 1982 and 1995 in 137 patients with clinical evidence of chronic paronychia or onycholysis. The purpose of the studies was to determine what factors played a role in these nail disorders. The culture results indicated that yeast commonly grew from the cultured material. Significant contact irritant exposure was frequently found. These findings and our experience suggest that the resolution of chronic paronychia and onycholysis depends on avoiding exposure to contact irritants and on appropriate treatment of any underlying fungal infection. To accomplish this latter goal, it is important to select a broad-spectrum antifungal agent that is effective against yeasts as well as other fungal pathogens.

Adolescent↗
PubMed1995

Interference in triiodothyronine (T3) analysis on the Immuno 1 Analyzer.

OBJECTIVE: To evaluate the interference in Triiodothyronine (T3) analysis on the Immuno 1 Analyzer. METHODS: We analyzed 686 samples for T3 using the Miles Technicon Immuno 1 Analyzer. We compared the results of 318 samples with those given by radioimmunoassay (RIA) and the remaining 368 results with those given by the Ciba-Corning ACS 180 analyzer. RESULTS: On the Immuno 1 correlated with those by RIA or chemiluminescence immunoassay. However, results on eight patients by the Immuno 1 method were anomalously elevated. We attempted to find and eliminate the cause of the interference on the Immuno 1. Although the method uses an alkaline phosphatase labelled T3 analog and fluoresceinated monoclonal antibody, serum binding of fluorescein or alkaline phosphatase did not appear to be the major causes of the interference. Ethanol extraction of samples followed by reconstitution in zero calibrator was the only reliable way to eliminate the interference. CONCLUSION: The Immuno 1 assay was more prone to interference than other methods. Until it is reformulated, we recommend that users assay ethanol extracts of samples with unexpectedly high T3.

Alkaline Phosphatase↗
PubMed1995

Decision making in the treatment of school-age children who stutter.

The purpose of this article is to provide clinicians information on some of the key issues in making decisions about the treatment process for children who stutter. Ten decisions that should be considered prior to, during, and at the time of dismissal are discussed. These decisions relate to a number of issues regarding treatment such as: increasing clinicians' confidence in treating stuttering in children, setting long- and short-term goals, selecting an approach to treatment, documenting progress, involving parents and teachers in the treatment process, and determining when the child is ready to be dismissed from treatment. Additionally, questions clinicians should ask themselves are presented with each of the ten decisions. The intent of this article is to show how an analysis of clinical information systematically collected over a period of time will help a clinician make accurate decisions about the treatment of children who stutter.

Adolescent↗
PubMed1995

Clinico-pathological predictors of recurrence for acinic cell carcinoma.

The biological behaviour of acinic cell carcinomas, even if well differentiated, is unpredictable. We studied 45 patients with acinic cell carcinoma followed-up from 10 to 379 months (5 year recurrence-free and survival rate of 69% and 81% respectively), and compared clinico-pathological parameters with outcome. The presence of a predominately solid architecture was strongly associated with a poor outcome (P < 0.01) and this was the only independent prognostic variable when log rank testing was performed. Tumour size (> 2.75 cm) was a significant predictor of recurrent deep parotid lobe involvement, the presence of cervical nodal disease and lymphocytic infiltration, although not significant, factors showed a tendency towards recurrence. For acinic cell carcinoma, the predominant solid architecture would appear to be a strong predictor of recurrence.

Adolescent↗
PubMed1994

Psychosocial problems in primary care. Pilot study of a new taxonomy.

BACKGROUND: In this study, the Massachusetts Academy of Family Practice Research Network (MAFP ReNet) was used to test a new taxonomy of psychosocial problems presenting to family physicians and to examine physician variability in determining when a psychosocial problem plays a role in a patient's visit. METHODS: Thirty physicians completed a form listing the taxonomy of psychosocial issues for 19 standard case vignettes. These physicians then completed the same form for every patient seen in their practices over a 2-week period. RESULTS: The proposed taxonomy was well received by practicing physicians as appropriate for how they think about their patients and practices. The case vignettes demonstrated a large variability in physician identification of psychosocial problems. The 30 physicians who participated in all phases of the study completed evaluations of 2876 patient visits, identifying 43% of these as involving one or more psychosocial problems. The frequency of psychosocial problem identification among the physicians ranged from 23% to 81%, with a standard deviation of 15%. CONCLUSIONS: The proposed new taxonomy may be helpful in both future research and teaching. The high degree of variation in physician responses both to the same clinical vignettes and to patients in their practices suggests that physicians vary widely in their identification of psychosocial issues.

Adult↗
PubMed1993

Feasibility of dose-intensive continuous 5-fluorouracil, doxorubicin, and cyclophosphamide as adjuvant therapy for breast cancer.

BACKGROUND: Several studies support the belief that the efficacy of adjuvant chemotherapy in breast cancer is related to the dose intensity of the chemotherapy used (expressed in milligrams per square meter per week). Retrospective analyses indicate that the actual delivered dose intensity may correlate more strongly with efficacy than the intended dose delivery. METHODS: A doxorubicin-based adjuvant regimen was studied for breast cancer. It was modeled on the Southwest Oncology Group's regimen of cyclophosphamide, methotrexate, and 5-fluorouracil in that daily oral cyclophosphamide and weekly intravenous 5-fluorouracil were used, but weekly doxorubicin was substituted for methotrexate and administered in both the adjuvant and neoadjuvant setting to 29 patients. RESULTS: The actual dose delivery was 1.21-1.24-fold that calculated for the delivered dose in the two other adjuvant regimens using the same three drugs (5-fluorouracil, doxorubicin, and cyclophosphamide) for which this could be determined. This regimen was tolerated well. Toxicity was minimal and consisted largely of expected neutropenia. CONCLUSIONS: Whether improved dose intensity can be increased further with the use of growth factors or actually confers improved outcomes awaits the results of larger future trials.

Adult↗
PubMed1993

The test-retest reliability of the Mini-Mental State Examination in chronic schizophrenic patients.

The test-retest reliability of the Mini-Mental State Examination (MMSE) was explored in a sample of 22 inpatients suffering from chronic schizophrenia by DSM-III-R criteria. Patients were tested 4 times during a period of 4-6 weeks. The total score for serial sevens showed consistently significant reliability at about 0.7, and the total score for spelling displayed a lower reliability at about 0.4, which was of borderline significance. In this short period of time, 36% and 27% of the patients shifted between being demented and nondemented when the serial sevens and spelling, respectively, were used to calculate total scores. The MMSE should not be used to categorize schizophrenics as demented or nondemented in biological studies using relatively stable variables.

Adult↗
PubMed1993

Attitude of healthcare personnel regarding influenza immunization.

OBJECTIVES: To survey the attitudes of healthcare personnel regarding influenza immunization. DESIGN: A questionnaire was given to all hospital employees. SETTING: A 650-bed community teaching hospital. INTERVENTION: Employees were offered an in-service regarding influenza immunization in October 1991. Influenza immunization was given free of charge by Employee Health Services from October to December 1991. One thousand fifty-six employees (30.2%) received influenza vaccines. Survey forms were distributed with paychecks to all employees during the second half of January 1992. Completed survey forms were returned during the next 2 weeks. RESULTS: One thousand two hundred three of the 3501 (34.3%) questionnaires were returned. Some of the survey forms were not completely filled out. A total of 28.1% of male employees (202/717) and 35.4% of female employees (987/2783) (p < .01) responded. Mean years employed were 11.35 +/- 7.57 for respondents and 9.30 +/- 7.39 for all employees (p < .001). Four hundred sixty-one respondents (38.4%) received the influenza vaccine and 734 (61.4%) did not. Among the respondents, employees who were older or working full time were more likely to receive the vaccine. Proportionally, more respondents who received the vaccine attended the in-service, although only 8.7% of those immunized attributed their receiving influenza vaccine to the in-service. More physician respondents were vaccinated. The respondents who received influenza vaccine were more likely to have received the vaccine during the past 2 years (p < .001). The major reasons given for not receiving the vaccine were "bad side effects" and "do not like shots." The major side effect of influenza immunization was a "sore arm." Multivariate analysis suggested that the in-service was not associated with obtaining the vaccine. CONCLUSIONS: The in-service regarding influenza immunization seemed to have a negligible influence. Most employees who received the vaccine had previous influenza immunization. There were no major side effects of influenza immunization. "Bad side effects" and "do not like shots" were major reasons given for not receiving influenza vaccine.

Adult↗
PubMed1992

Captopril test in children with reflux nephropathy.

We studied the plasma renin activity (PRA) and blood pressure (BP) responses to a single oral dose of captopril in children with renal scarring due to vesicoureteral reflux. The test was performed on 19 children, of whom 13 were normotensive and 6 hypertensive. Basal PRA was within the normal range for age for all except 1 patient. Mean basal PRA values for normotensive and hypertensive patients were not significantly different. At 90 min post captopril, the mean PRA increase was 3.61 ng/l per second (SD = 7.07) in the normotensive group but only 0.77 ng/l per second (SD = 0.83) in the hypertensive group. In 11 patients the average systolic BP 60-90 min post captopril was 0.9%-12.4% lower than the basal value. Diastolic BP decreased after captopril administration in 10 patients and increased in 9. The changes in mean arterial pressure and PRA between 0 and 90 min post captopril were inversely correlated (r = 0.605, P less than 0.01). Because of the PRA responsiveness in the normotensive patients with renal scarring, we suggest that there was activation of the renin-angiotensin axis in this group. However, it is not apparent whether such patients are more at risk of developing hypertension at a later time.

Adolescent↗
PubMed1992

Vaginal PO2 in healthy women and in women infected with Trichomonas vaginalis: potential implications for metronidazole therapy.

We measured the PO2, pH, and temperature in the vaginal canals of nine patients with symptomatic Trichomonas vaginitis and those of 10 healthy women. The patients included eight women with primary infections caused by metronidazole-susceptible strains and one refractory case that resulted from infection with a metronidazole-resistant Trichomonas vaginalis. The median vaginal PO2, pH, and temperature in the patient group were 1 mm Hg, 6, and 37.3 degrees C respectively; these medians were 1 mm Hg, less than or equal to 4.5, and 37.2 degrees C in the healthy group. These data show that vaginal environment is anaerobic or microaerophilic (it has reduced oxygen tension). Because the activity of metronidazole is reduced under aerobiosis, the vaginal environment should enhance the biologic activity of the drug.

Adult↗
PubMed1992

Identification of the steroids in neonatal plasma that interfere with 17 alpha-hydroxyprogesterone radioimmunoassays.

Neonatal plasma contains interferents that increase the apparent 17 alpha-hydroxyprogesterone (17-OHP) content measured by direct (no-extraction) radioimmunoassay. We fractionated extracts from neonatal plasma pools by liquid chromatography with a Sephadex LH-20 column and measured 17-OHP immunoreactivity by a direct test kit. We found immunoreactivity in the free steroid and glucuronide fraction and also in the monosulfate fraction. We analyzed these two fractions by reversed-phase high-performance liquid chromatography (HPLC) and HPLC-mass spectrometry. We collected fractions and assayed for 17-OHP immunoreactivity. The HPLC fractions containing the interfering steroid monosulfates were analyzed by ion-spray mass spectrometry and, after solvolysis, by gas chromatography-mass spectrometry. Several monosulfates were identified, including those of 17 alpha-hydroxy-pregnenolone, 16 alpha-hydroxypregnenolone, pregnenolone, and several pregnenetriols. 17 alpha-Hydroxypregnenolone sulfate was the most significant interferent. Other commercially available 17-OHP assays showed similar interference when used without an extraction step. Kit manufacturers should select antibodies and protocols to minimize cross-reaction with sulfates, especially 17 alpha-hydroxypregnenolone sulfate.

17-alpha-Hydroxyprogesterone↗
PubMed1991

Expression of Her-2/neu oncogene protein product and epidermal growth factor receptors in surgical specimens of human breast cancers.

Her-2/neu protein product was immunocytochemically analyzed in 139 breast cancers. Epidermal growth factor receptors were similarly analyzed in 74 breast cancers from the same patient pool. These results were also separated on the basis of estrogen receptor proteins and of combined aneuploidy with elevated S-phase from flow cytometry. Invasive breast cancer yielded a positive label for Her-2/neu protein (26%) and for epidermal growth factor receptor (25%), with no significant difference. Correlations with estrogen receptor labeling yielded differences significant inversely for both Her-2/neu protein (p less than 0.02) and epidermal growth factor receptor (p less than 0.01). Positive Her-2/neu protein labels correlated with a positive combination of aneuploidy and elevated S-phase (37%) and a negative combination of aneuploidy and elevated S-phase (21%), with a statistically nonsignificant difference. Positive epidermal growth factor receptor cases with aneuploidy and an elevated S-phase (75%) and without aneuploidy and elevated S-phase (42%) did differ with significance at p less than 0.05. There were eight cases positive for both Her-2/neu protein and epidermal growth factor receptor, four of six cases with negative estrogen receptor, four of six cases with negative estrogen receptor, six of six cases aneuploid, and five of six cases with an elevated S-phase. All eight cases had threatening disease--either stage III or stage IV, with one case of extensive ductal carcinoma in situ (comedo). Correlation of negative Her-2/neu protein with negative epidermal growth factor receptor was significant (p less than 0.05) in 74 cases. However, positive Her-2/neu protein did not correlate with positive epidermal growth factor receptor; there was a trend toward inverse correlation. We conclude that epidermal growth factor receptor labeling results show similarities to Her-2/neu protein results, but epidermal growth factor receptor tended to correlate with unfavorable ploidy and S-phase. Epidermal growth factor receptor labeling might be useful in breast cancers with macrocysts reported to show high epidermal growth factor activity.

Adult↗