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Biomedical subjects

I S Jones

Publications and source records attributed to I S Jones.

At least 19 recordsLinked to original sources

Radiation retinopathy: electron microscopy of retina and optic nerve.

A 4 1/2 year old female was treated for embryonal rhabdomyosarcoma of the left orbit in 1975 with radiation (59.5 Gy in 5 weeks), followed by chemotherapy. An electroretinogram (ERG) in March, 1988 revealed cone responses 3% of normal and no rod responses in the left eye, and normal responses in the right eye. The eye was enucleated in April 1988. In the fovea no choroidocapillaris was seen at the intact Bruch's membrane, and the pigment epithelium was preserved only in small patches. No photoreceptor cells were seen in the areas devoid of pigment epithelial cells. The parafoveal and peripheral (30 degrees eccentricity) retina was better preserved. The thickness of the layer of rods and cones and of Henle's fiber layer was reduced. Very few outer segments were present. Macrophages had invaded the retinal tissue in moderate numbers. The retinal vessels were ensheathed by several layers of collagen fibrils. The spatial densities of pigment epithelial, cone, rod, and bipolar cells had been reduced. The optic nerve contained a total number of 1,022,000 nerve fibers.

Child, Preschool

Sodium and volume dysregulation after apparently normal pregnancy is suggested by abnormal levels of atrial natriuretic peptide, renin and aldosterone.

1. Plasma atrial natriuretic peptide (ANP), renin activity, aldosterone, sodium, potassium and serum total protein and albumin during and after 14 normal pregnancies were compared with age-matched controls. 2. None developed toxaemia and all delivered healthy babies. 3. During pregnancy, plasma renin activity and aldosterone were significantly (P less than 0.01) higher and potassium, total protein and albumin significantly lowew (P less than 0.01) than in controls, while ANP was not different from the control level. 4. At 6-13 weeks postpartum, a significant (P less than 0.01) suppression of renin and aldosterone was accompanied by significant (P less than 0.01) elevation of atrial natriuretic peptide when compared with controls. 5. The hormonal changes are consistent with 'effective plasma volume' reduction during pregnancy and persistent volume expansion after pregnancy, perhaps due to a renal glomerular lesion sustained late in pregnancy. In contrast, levels of potassium, total protein and albumin are consistent with haemodilution during pregnancy and its correction postpartum. 6. Measurements available in seven women 40-120 weeks postpartum showed normal renin and aldosterone levels in most, but ANP was still elevated. 7. Pregnancy may have a protracted effect on volume regulation.

Adult

Defective equipment and tractor-trailer crash involvement.

The role of defective equipment in large truck crashes on interstate highways in Washington State was investigated using a case-control study design. For each large truck involved in a crash, three trucks were randomly selected from the traffic stream at the same time and place as the crash, but one week later both crash and comparison trucks were inspected by Commercial Vehicle Enforcement officers of the Washington State Patrol. The effects of truck equipment condition, truck operating characteristics (carrier type, carrier operation, and truck load), and driver characteristics (driver age, hours of driving) on crash involvement were analyzed by comparing their relative frequency among crash-involved and comparison sample tractor-trailers. A logistic regression model was used to estimate the adjusted odds ratio for each factor. Overall, 77% of tractor-trailers in crashes and 66% of those not involved in crashes had defective equipment warranting a citation. Forty-one percent in crashes had defective equipment warranting taking the truck out of service, and 31% not in crashes had these defects. Brake defects were the most common type and were found in 56% of tractor-trailers in crashes; steering equipment defects were found in 21%. The relative risk of crash involvement for trucks with brake defects was about one and one-half times that for trucks without brake defects. For trucks with steering defects, the relative risk of crash involvement was at least twice that for trucks with steering defects, the relative risk of crash involvement was at least twice that for trucks without defects, and the risk increased substantially for trucks with out-of-service steering defects.

Accidents, Traffic

Trauma triage: vehicle damage as an estimate of injury severity.

Field triage of injured patients has the objective of rapid identification of that 5-10% with injuries serious enough to pose a risk to life. The process requires not only the identification of patients with abnormal physiology, but also those whose physiology is normal despite the fact that significant anatomic injury may exist. This paper defines relationships by which vehicle damage information available at the accident may augment the physiologic measures used for triage decisions. Vehicle velocity changes of 20 m.p.h. or more in direct frontal collisions, 22 m.p.h. or more in offset frontal collisions, and 15 m.p.h. or more in side impacts captured 90% of the patients with Injury Severity Scores of 16 or greater. The amount of vehicle damage observed with these velocity changes was found to be 20 inches of crush in direct frontal collisions, 28 inches of crush in offset frontal collisions, and 15 inches of damage in side impacts. Incorporating these findings into triage of trauma patients who exhibit normal vital signs at the accident scene may provide a more structured basis for field triage.

Accidents, Traffic

Predicting injury risk with "New Car Assessment Program" crashworthiness ratings.

The relationship between crashworthiness ratings produced by the National Highway Traffic Safety Administration's (NHTSA's) New Car Assessment Program (NCAP) and the risk of incapacitating injury or death for drivers who are involved in single-car, fixed-object, frontal collisions was examined. The results are based on 6,405 such crashes from the Motor Vehicle Traffic Accident file of the Texas Department of Highways and Public Transportation. The risk of injury was modeled using logistic regression taking into account the NCAP test results for each individual model of car and the intervening effects of car mass, age of the driver, restraint use, and crash severity. Three measures of anthropometric dummy response, Head Injury Criterion (HIC), Chest Deceleration (CD), and femur load were used to indicate vehicle crash test performance. The results show that there is a significant relationship between the results of the NCAP tests and the risk of serious injury or death in actual single-car frontal accidents. In terms of overall injury, chest deceleration was a better predictor than the Head Injury Criterion. For restrained drivers, crash severity, driver age, and chest deceleration were significant parameters for predicting risk of serious injury or death; the risk of injury decreased as chest deceleration decreased. The results were similar for unrestrained drivers although vehicle mass and femur load were also significant factors in the model. The risk of overall injury decreased as chest deceleration decreased but appeared to decrease as femur load increased.

Accident Prevention

Crash involvement of large trucks by configuration: a case-control study.

For a two-year period, large truck crashes on the interstate system in Washington State were investigated using a case-control method. For each large truck involved in a crash, three trucks were randomly selected for inspection from the traffic stream at the same time and place as the crash but one week later. The effects of truck and driver characteristics on crashes were assessed by comparing their relative frequency among the crash-involved and comparison sample trucks. Double trailer trucks were consistently overinvolved in crashes by a factor of two to three in both single and multiple vehicle crashes. Single unit trucks pulling trailers also were overinvolved. Doubles also had a higher frequency of jackknifing compared to tractor-trailers. The substantial overinvolvement of doubles in crashes was found regardless of driver age, hours of driving, cargo weight, or type of fleet. Younger drivers, long hours of driving, and operating empty trucks were also associated with higher crash involvement.

Accidents, Traffic

An assessment of vulval pigmentation.

Thirty-five vulvectomy specimens were obtained from post-mortem material and studied to assess the distribution of melanin pigment. The information obtained was compared with the melanin distribution in melanoma-in-situ and melanosis vulvae. A lesion had to be larger than 3mm before it was recognised clinically. Melanosis vulvae is but an exaggeration of the normal distribution of melanin pigment. Melanoma-in-situ, however, cannot be reliably distinguished from the benign causes of pigmentation on clinical grounds. The correct diagnosis can only be made histologically. Other causes of vulval pigmentation are also discussed.

Aged

Orbitofacial angiomatosis.

Two patients with orbital vascular malformation ipsilateral facial nevus flammeus were studied. The literature contains one similar case that interestingly shares with our cases the lack of leptomeningeal angiomatosis. Orbitofacial angiomatosis seems to be a distinct entity from meningofacial angiomatosis because of its true vascular malformation of the orbit.

Angiomatosis

Benign epithelioid cell nevi of the iris.

Two benign acquired melanocytic lesions of the iris stroma had distinctive clinical and pathologic features. One tumor was loculated and polypoid, suggesting ectopic glandular tissue, while the other was a flat tumor with a rich surface capillarity. Both lesions histologically were composed of mononucleated, binucleated, and multinucleated hypopigmented epithelioid and elongated "myoid" cells, widely separated in a finely fibrillar eosinophilic stroma. The ultrastructural features of one case included hyperconvoluted nuclei, conspicuous cytoplasmic filaments are rare, filamentary-striated (leptomeric) structures, scant organelles and inclusions except for numerous mitochondria and glycogen granules, small and infrequent melanosomes, and a fibrillary extracellular matrix focally organized into banded basement membrane material.

Adult

Capillary hemangioma of the lids and orbit: an analysis of the clinical features and therapeutic results in 101 cases.

The clinical records of 101 patients (biopsies done on 48) with capillary hemangiomas of the orbit, orbit and lids, and lids were analyzed. Lesions predominated in females and typically appeared at birth or within the first two months of life. The superior orbit and lids were definite sites of predilection. Telltale periocular cutaneous involvement occurred in one third of the cases. Pure proptosis caused by a deep orbital tumor without an anterior component was found in seven cases. Proptosis in general was mild, but in two cases was severe enough to cause corneal exposure. Findings suprortive of a diagnosis of an orbital or periorbital hemangioma include (1) change in tumor size on crying (46%); (2) a dark vascular coloration to the subcutaneous tissue (80%); and (3) the existence of nonperiocular strawberry marks (25). Diagnostic tests of most value were plain radiography, ultrasonography, computed axial tomography, and arteriography. The complication rate in the 50 patients followed up over five years was 80% (60% with amblyopia). Present treatment modalities do not appear to be achieving the desired goals of a good cosmetic and functional outcome. Radiotherapy and corticosteroids are both effective in individual cases, but many lesions are resistant to all forms of present treatment. Amblyopia therapy is difficult and often unsuccessful in these patients.

Age Factors

Pulsating metastatic tumor of the orbit.

A 47-year-old white man in apparent good health had diplopia and swelling of the right upper eyelid. Ocular examination showed proptosis of the right eye, together with a large, pulsatile, collapsible mass simulating a vascular neoplasm and involving the right temple as well as the right upper outer quadrant of the orbit. Biopsy of the orbital tumor disclosed a clear-cell carcinoma compatible with a renal primary tumor; subsequent laboratory examination revealed the offending tumor in the left kidney. Renal carcinomas may metastasize to the globe or to the orbit before the primary tumor is recognized. Pulsatile exophthalmos acquired in middle life associated with significant bone destruction represents a constellation of findings most consistent with a metastatic tumor, probably renal carcinoma, caused by the exceedingly rich vascularization of these metastatic deposits.

Adenocarcinoma

An assessment of vulval lichen sclerosus.

Vulval lichen sclerosus (L.S.) has been assessed clinically, colposcopically, and histologically to ascertain the suitability of including this condition in the nomenclature proposed by the International Society for the Study of Vulval Disease (I.S.S.V.D). In many cases the macroscopic appearance of lichen sclerosus is characteristic, but this is not always the case. Histologically, the appearances of the dermal hyaline change, the reduction in the length and the number of rete pegs, to a lesser extent thinning of the dermis and sometimes thinning of the epidermis are characteristics. The presence of dermal inflammatory cells and changes in the thickness of the keratin layer are, however, much more variable. Exact measurements of the various layers of the vulval skin are not necessary in the routine assessment of lichen sclerosus. The present study justifies the inclusion of lichen sclerosus on histological criteria in the I.S.S.V.D.'s nomenclature.

Female

Ovarian teratoma with peritoneal gliomatosis.

The case report describes the clinical and pathological features of a young girl with ovarian teratoma which showed a predominance of neural tissue. The peritoneal involvement by an admixture of mature and immature glial tissue resulted in the death of the patient despite surgery and cytotoxic chemotherapy. There was an association between this tumour and the presence of carcinoembryonic antigen and alphafetoprotein in the serum and ascitic fluid.

Adolescent