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Biomedical subjects

J M Vincent

Publications and source records attributed to J M Vincent.

At least 37 records · Page 2Linked to original sources
PubMed1994

Computed tomography of diffuse, non-metastatic enlargement of the adrenal glands in patients with malignant disease.

The aim of this study was to test the hypothesis that diffuse non-metastatic enlargement of the adrenal glands occurs in patients with malignant disease. Measurements of the adrenal glands were obtained from computed tomographic (CT) images in two groups of patients with malignant disease (47 patients with lymphoma and 144 patients with other primary tumours) and a control group consisting of 55 patients without malignant disease. Patients with conditions known to affect the adrenal glands were excluded. Adrenal glands with focal mass lesions, as judged by CT, were also excluded. The following measurements were obtained: the maximum width perpendicular to the long axis of the gland; and maximum width of the medial and lateral limbs. There was a statistically significant difference in all measurements between the control group and the groups with lymphoma and other tumours. No significant difference was demonstrated in the size of the adrenal glands in patients with different stages of malignancy. We have shown that the adrenal glands are enlarged in patients with malignant tumours, including lymphoma. We believe that this enlargement is due to adrenal hyperplasia rather than to metastatic neoplasm.

Adrenal Glands↗
PubMed1994

The radiology of non-Hodgkin's lymphoma in childhood: a review of 80 cases.

The clinical spectrum of childhood non-Hodgkin's lymphoma (NHL) is different from that in adults, with frequent extranodal involvement. CT scanning as part of routine staging appears to show more frequent sites of extranodal disease than were previously recognized. We have reviewed the CT and other radiological findings in 80 children with NHL to document the incidence and radiological appearance of visceral involvement, to compare this with the pattern of adult disease, and to assess how frequently clinical stage of disease was altered by radiological findings. The age of the children ranged from 9 months to 17 years 4 months (mean 9 years 2 months). The presenting site was in the abdomen in 21 (27%), extranodal sites in the head and neck in 18 (23%), mediastinum in 16 (20%), peripheral lymph nodes in 15 (19%), pelvic organs in four, skin in four, and bone in two. Fifteen children had gastrointestinal lymphoma, the majority involving the ileocaecal junction. The kidneys were involved in 10 children, the pancreas in three; no child with renal or pancreatic involvement had associated retroperitoneal lymph node enlargement. Eight children had bone involvement and only two of the 80 children had pulmonary nodules at presentation. In this series, of the 44 children who had CT of the chest and abdomen, only five had stage of disease increased as a result, three with the primary disease in peripheral lymph nodes, and two with the primary disease in extranodal sites in the head and neck.

Abdominal Neoplasms↗
PubMed1993

The radiological investigation of occult ectopic ACTH-dependent Cushing's syndrome.

The radiological features of 14 patients with Cushing's syndrome due to 'occult' ectopic ACTH syndrome have been reviewed. In 11 of the 14 patients (79%), the ACTH-producing tumour was located in the thorax. Bronchial carcinoid tumours (eight patients) were the single most common source of 'occult' ectopic ACTH production with thymic carcinoid tumours (two patients) and mediastinal metastases from a medullary carcinoma of the thyroid gland (one patient) accounting for the other intrathoracic tumours. The tumours were usually small with five of the eight bronchial carcinoid tumours measuring between 4 and 10 mm in diameter. Since it remains difficult to distinguish between pituitary-dependent Cushing's disease and 'occult' ectopic ACTH-dependent Cushing's syndrome both clinically and biochemically, the role of radiology remains vital.

ACTH Syndrome, Ectopic↗
PubMed1993

Antimicrobial treatment of occult bacteremia: a multicenter cooperative study.

This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1993

Vertebral 'corner' defect associated with lumbar disk herniation shown by magnetic resonance imaging.

Two examples of a marked defect of the corner of the vertebral body adjacent to an intervertebral disk herniation are presented. The prevalence of this finding was assessed in 43 randomly selected patients with disk herniation (at 46 levels). None of these patients had such marked vertebral defects (moderate changes at 3 levels; minor in 23). Although the defects were seen more often in younger patients, adjacent to large herniations, and in those with substantial cranial or caudal migration, these associations did not reach statistical significance. However, the site of the defect, when associated with disk migration, correlated with the direction of the migration. It is considered likely that this defect is caused by a purely mechanical effect, but its possible relationship to developmental factors is discussed.

Adolescent↗
PubMed1992

Case report: primary lymphoma of bone--MRI appearances with pathological correlation.

A case of primary lymphoma of bone involving the proximal tibia is presented. The magnetic resonance (MR) appearances were unusual for a primary malignant tumour, with predominantly low signal intensity on both T1- and T2-weighted images. This correlated with marked fibrosis on histology. These observations are discussed in the context of previous reports of MRI in bone lymphoma.

Adult↗
PubMed1992

Effects of pulmonary function of oral high frequency oscillation in normal and asthmatic subjects.

High frequency jet devices are not only used as 'internal percussors' to aid clearance of pulmonary secretions, but are also a mode of ventilatory support. As physical stimuli can cause bronchospasm in asthmatic individuals, we hypothesized that direct airway vibration may induce bronchospasm. To ascertain whether an airway vibration jet device could cause bronchoconstriction, we exposed eight asthmatic and six normal subjects to 5 min of jet-induced airway vibration or placebo treatment with cross-over at 3 h. Subjects breathed spontaneously for 5 min through an open mouthpiece into which either jet (10 Hz, 25 psi) or sham pulsations (same device, pressure vented to room at compressor) were delivered in a double-blind, random order. A constant-volume body plethysmography measured functional residual capacity and specific airway conductance (SGAW) and a water seal spirometer measured forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). These pulmonary function measurements were taken before and at 5, 10, 20, 30, 60, 90 and 120 min after each exposure. In the normal subjects there was no significant change in any pulmonary function. There was not statistically significant change in the pulmonary function in the asthmatic patients. However, the oral high frequency oscillator induced a clinical asthmatic attack in one asthmatic patient. In this one patient, the FEV1 fell 35% from its initial value at 5 min following exposure to a maximum of 49% decline from initial value at 1 h following exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Extrinsic allergic alveolitis: problems in diagnosis and a potential use for computed tomography.

Bird fancier's lung, the most common form of extrinsic allergic alveolitis in Britain, can be a difficult diagnostic problem. The symptoms are non-specific, often insidious in onset and frequently misdiagnosed as influenza or a viral or bacterial pneumonia. Frequently there is a delay in eliciting the history of exposure to the antigen. The chest radiograph is often less impressive than the clinical presentation and may be normal despite severe symptoms, impaired respiratory function and florid pathological changes. We present three cases demonstrating these diagnostic problem. In two cases, high resolution computed tomography demonstrated the typical 'ground glass' opacification seen in active alveolitis. This allowed targeting of transbronchial biopsies which revealed an inflammatory infiltrate of the interstitium with granuloma formation and inflammatory cells in some alveoli. The problems in diagnosis and the potential role of high resolution computed tomography are discussed.

Adult↗
PubMed1992

Radiology of lung cancer.

Papers in the review period have investigated the reasons why radiologists frequently overlook early lung cancers and have demonstrated that the rate at which radiologists falsely categorize a solitary pulmonary nodule as benign, through the use of commercially available CT phantom densitometry is higher than was previously believed. Attempts have also been made to find CT characteristics other than density that may help to distinguish benign from malignant nodules. A number of articles have addressed methods of improving the yield and reducing the pneumothorax rate following needle biopsy of pulmonary nodules. The major role of the radiologist when evaluating patients with known or probable lung cancer is to stage the tumor. The recent literature describing the accuracy of CT and MR imaging in staging lung cancer is also reviewed.

Biopsy, Needle↗
PubMed1991

Antigenuria after immunization with Haemophilus influenzae oligosaccharide CRM197 conjugate (HbOC) vaccine.

We tested the urine of 30 infants 6 weeks to 7 months of age after they received standard 10-micrograms (0.5-ml) doses of HbOC (HibTITER) Haemophilus influenzae b (Hib) conjugate vaccine for the presence of Hib antigenuria using a commercially available latex particle agglutination assay (Directigen). Urines were collected within 1 hour, from 1 to 3 hours, at 24 hours and at 3, 6 and 9 days after vaccine administration and reactions were quantitated from 0 to 3+. In contrast to previous studies in older children which showed little or no antigenuria following HbOC vaccination, our study shows that in infants intense Hib antigenuria is evident within 2 to 3 hours and persists 3 days after vaccine administration and that less intense antigenuria may be detected in some infants for several days. With efficacious vaccines now being used in 2- to 6-month-old infants, invasive Hib disease may soon be limited to infants of this age just before their seroconversion. It should be recognized that antigenuria occurs for several days after vaccination with Hib conjugate vaccines and that it could be erroneously interpreted as evidence of invasive Hib infection.

Antigens, Bacterial↗
PubMed1991

Detection and diagnosis of the primary tumor in lung cancer.

The role of radiology in the initial detection and diagnosis of primary lung cancer is well established. Recent advances in the detection of lung cancer stem from research into the visual search patterns used by a radiologist when reading a chest radiograph. Computer feedback of "visual-dwell" positions can lead to an increase in true-positive detection of lung nodules and decrease the false-positive rate. Plain film radiography and CT continue as the mainstays for the characterization of lung nodules. New studies involving the use of conventional tomography to detect contrast enhancement of malignant lesions and the use of axial multiplanar reconstruction CT to demonstrate involvement of pulmonary veins by malignant lesions are detailed. Transbronchial and percutaneous transthoracic biopsy techniques are widely used to diagnose the nature of solitary pulmonary nodules. The dependent positioning of the biopsy site has been shown to decrease both the pneumothorax rate and the frequency of chest drain insertion, whereas the blood patch technique was shown not to affect the pneumothorax rate at all.

Diagnostic Imaging↗
PubMed1991

Antimicrobial drug suspensions: a blind comparison of taste of fourteen common pediatric drugs.

Children of preschool age most often receive medications in liquid form, and smell and taste are major determinants in achieving compliance. We compared smell, taste and other characteristics of 14 commonly prescribed antimicrobial suspensions in a blind test in 30 adult volunteers to determine whether there was a difference in their acceptability. A significant difference was observed with cephalosporins ranking highest and penicillins ranking lowest. Our findings support anecdotal observations and claims often made by parents that cephalosporin antimicrobial suspensions taste good and are readily accepted by children and that penicillin suspensions have an unpleasant taste and aftertaste and are poorly accepted. Other drugs had intermediate scores. Of the two erythromycin suspensions evaluated, Ilosone tested superior to Erythromycin ES.

Adult↗
PubMed1989

Adult respiratory distress syndrome from overdose of tricyclic antidepressants.

Adult respiratory distress syndrome (ARDS) from overdose of tricyclic antidepressants (TCA) has been reported but is not well known. During a 1-year period, 81 patients with serious overdose from tranquilizers and other psychotropic drugs were examined. TCA alone induced overdose in 30 patients or were combined with other drugs in 26 patients. Twenty-five (31%) patients had overdose from drugs other than TCA. Chest radiography revealed that 30 (54%) patients with TCA overdose and six (24%) patients with non-TCA overdose had abnormalities. Clinical and radiographic findings consistent with ARDS were noted in five (9%) patients with TCA overdose and none of the patients with non-TCA overdose. Five patients with TCA overdose and one (4%) patient with non-TCA overdose had interstitial edema that never progressed to ARDS. TCA should be added to the list of drugs associated with the development of ARDS.

Antidepressive Agents, Tricyclic↗