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Biomedical subjects

J M Parsons

Publications and source records attributed to J M Parsons.

47 records · Page 3Linked to original sources

Balloon dilatation of a stenosed modified (polytetrafluoroethylene) Blalock-Taussig shunt.

A 17 month old girl with tricuspid atresia, ventricular septal defect, subvalvar and valvar pulmonary stenosis, and increasing cyanosis had angiographic evidence of proximal stenosis of a right modified (5 mm diameter) Blalock-Taussig shunt. She underwent palliative balloon angioplasty with a 6 mm Schneider balloon catheter. Successful dilatation was achieved without complication. Four months later there was subjective clinical improvement with a rise in systemic arterial saturation. Repeat angiography showed patency of the shunt without restenosis or formation of an aneurysm.

Anastomosis, Surgical↗

Magnetic resonance imaging at a high field strength of ventricular septal defects in infants.

Magnetic resonance imaging at a high field strength has potential benefits for the study of the heart in infants, which is when most congenital heart disease presents. Seventeen infants with various anatomical types of ventricular septal defect were studied by this technique. Good quality, high resolution, images were obtained in every case. There were no major practical problems. The morphology of the defects in all 17 hearts was displayed in great detail. In some instances, the interpretation of the images resembled that of equivalent images from cross sectional echocardiography. But this new technique allowed imaging in planes that cannot be obtained by echocardiography. One particularly valuable plane gave a face on view of the inlet and trabecular components of the septum. This allowed very precise localisation of defects in these areas. The relation between the defects and the atrioventricular and arterial valves was exceptionally well shown in various different imaging planes. One patient in the series had multiple trabecular defects that were clearly shown. Magnetic resonance imaging gives detailed morphological information about ventricular septal defects.

Heart Septal Defects, Ventricular↗

Eosinophils in skin lesions of erythema multiforme.

To investigate the controversy regarding the presence of eosinophils in skin lesions of erythema multiforme, we undertook a retrospective clinicopathologic study of 19 recent cases that fulfilled clinical and histopathologic criteria for the disease. At least a few eosinophils were observed in 13 of 19 cases, and in four cases there were more than three per high-power field, qualifying as "tissue eosinophilia." Immunofluorescence studies in three cases with eosinophils failed to show the linear basement membrane zone fluorescence characteristic of bullous pemphigoid. Giemsa stains revealed that mast cells were present in lesions both with and without eosinophils. The only clinical features that distinguished patients with tissue eosinophilia from those without were an older age of incidence and a longer duration of disease prior to biopsy. Drugs were implicated as a causative factor in some patients both with and without eosinophils, but all four patients with tissue eosinophilia were believed to have drug-induced disease. We conclude that eosinophils do occur in skin lesions of erythema multiforme and are occasionally numerous.

Adult↗

Cutaneous involvement of multiple myeloma and extramedullary plasmacytoma.

We recently performed a retrospective clinicopathologic study of five patients with cutaneous involvement of multiple myeloma or extramedullary plasmacytoma. Cutaneous nodules without extension from an underlying bony focus of disease developed in each case. In two cases skin lesions occurred in the more common setting of advanced disease, but in two others skin lesions provided early clues to the diagnosis. In three patients the appearance of skin lesions heralded a rapidly deteriorating clinical course, but two other patients had reasonably long survivals despite cutaneous disease (6 and 3 years, respectively). Two histopathologic configurations were identified in cutaneous lesions: nodular and infiltrative. Both patients with the latter form had multiple myeloma. In all cases tumor cells were pyroninophilic. Immunoperoxidase studies on fixed, paraffin-embedded tissues confirmed the electrophoretic findings in two cases, but findings were equivocal in three others. In one case, cells were positive for epithelial membrane antigen, and in another, alpha 1-antichymotrypsin-positive cells were observed in the centers of tumor islands. Cutaneous involvement with plasma cell neoplasms is recognized infrequently. Immunohistochemical techniques may prove to be valuable in evaluating these cases, but they are not without technical and interpretative difficulties.

Aged↗

Infective endarteritis affecting the left pulmonary artery after anatomical correction of complete transposition of the great arteries.

Clinical features of infective endocarditis developed in a two year old boy. He had successfully undergone anatomical correction of complete transposition of the great arteries during the neonatal period. At routine investigation one year later he showed evidence of important supravalvar pulmonary stenosis. He remained symptom free until endocarditis developed. Streptococcus pneumoniae was isolated from serial blood cultures. Despite prompt treatment with specific intravenous antibiotic treatment the patient died of overwhelming sepsis. At necropsy the stenosed portion of the left pulmonary artery was seen to be the site of infection.

Arterial Occlusive Diseases↗

Pityriasis rosea update: 1986.

Pityriasis rosea is a common self-limited dermatologic disorder. It appears to be a nonspecific cutaneous reaction pattern with a large number of causes. Current evidence indicates that a cell-mediated immune mechanism may be important in its pathogenesis.

Diagnosis, Differential↗

Mortality of paint and coatings industry workers. A follow-up study.

Extensive follow-up of production workers in the paint and coatings industry failed to indicate any important hazard that was previously unsuspected. The authors are more confident of the results of their original study since studying a subsample of persons lost to follow-up in the original study. Some efforts to investigate certain diseases (skin and liver cancer) more vigorously met with failure, which illustrates the problem of attempting retrospective studies by using death certificates for case ascertainment. Of the successful studies, the leukemia case-control analysis showed a possible relationship to lacquer production, which probably included benzene exposure. For lung cancer, no exposure category was associated with increased risk. The bowel cancer excesses, concentrated in three plants, are probably not job related and in any case do not represent an industry-wide problem. Cerebrovascular accidents showed a mild elevation of risk for vehicle workers. Although strong statements concerning the safety of this industry probably await more studies or further follow-up of this cohort, there is every indication that it is an industry without a major excess of any job-related disease. In drawing this conclusion, however, one must be aware that an individual job or individual plant could harbor health problems that would not be detected by a study of this type.

California↗

Management of toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a medical emergency requiring the combined efforts of specialists from multiple disciplines. A basic guide to the management of the seriously ill patient with this disorder is provided.

Adult↗

Potential virulence determinants in terminal regions of variola smallpox virus genome.

Smallpox eradication culminated the most successful antimicrobial campaign in medical history. To characterize further the linear double-stranded DNA genome of the aetiological agent of smallpox, we have determined the entire nucleotide sequence of the highly virulent variola major virus, strain Bangladesh-1975 (VAR-BSH; 186,102 base pairs, 33.7% G + C; Genbank accession number, L22579). Here we highlight features of the molecule and focus on a few of the 187 putative proteins that probably contribute to pathogenicity and virus host-range properties. One hundred and fifty proteins were markedly similar to those of vaccinia virus (smallpox vaccine), for which a complete sequence has been reported for strain Copenhagen (VAC-CPN; 191,636 base pairs, 33.3% G + C). The remaining 37 proteins reflected variola-specific sequences or open reading frame divergences for variant proteins, which are often truncated or elongated compared with their vaccinia counterparts.

Animals↗