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Biomedical subjects

J R Gray

Publications and source records attributed to J R Gray.

18 recordsLinked to original sources
PubMed1992

Cigarette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus.

The authors studied the cigarette and alcohol use of 243 patients with adenocarcinoma of the cardia or lower esophagus, including 66 with Barrett's metaplasia (esophagocardia group). They compared results of that investigation with the cigarette and alcohol use of 303 patients with squamous carcinoma of the esophagus, a cancer in which an etiologic association is proven, and of 338 patients with stomach cancer not involving the cardia, a cancer in which there is little or no association with cigarettes or alcohol. Controlled for other variables, patients with squamous cancer used more cigarettes and alcohol than the other two groups. There was no significant difference in cigarette or alcohol use between patients with esophagocardia and stomach cancer or between those in the esophagocardia group with or without Barrett's metaplasia. Because cigarette and alcohol use was not greater in patients with esophagocardia than in those with stomach cancer, the authors do not think that such factors explain the increasing incidence of adenocarcinoma of the cardia or lower esophagus.

Adenocarcinoma↗
PubMed1992

Marfan syndrome in a large family: response of family members to a screening programme.

Reaction to medical, social, and genetic implications of Marfan syndrome was evaluated by means of two questionnaires, the first after various tests before discussion of the diagnosis, the second after full discussion of the patient's diagnosis. Thirty-seven members of a family known to be at risk for Marfan syndrome attended for both questionnaires. All patients claimed to be satisfied with the way they were informed of the results of screening; 41% of patients were more worried about their health and 48% were more worried about the future after diagnosis. Apart from 50% of the smokers reducing or stopping their intake of cigarettes there were only very minor changes in lifestyle over the first month despite the increased level of expressed anxiety. If a definitive screening test was available, 96% of patients claimed they would have chosen it, 45% felt it would have an influence on their future plans, and 78% would choose to use a method of prenatal diagnosis for Marfan syndrome if it were available.

Adolescent↗
PubMed1992

Patient and renal allograft survival in the late posttransplant period.

Finding the proper balance between too much and not enough immunosuppression is just as important in the late posttransplant period as it is during the first year after transplantation. In general, too much immunosuppression leads to an increase in patient mortality, whereas inadequate immunosuppression can lead to an inordinately high rate of allograft failure (Fig 5). In the late posttransplant period, patient and allograft survival are both critically dependent on the degree of immunosuppression and on the long-term side effects of the agents used to achieve this immunosuppression. Adequate immunosuppression is important in treating and preventing the acute allograft rejection episodes that are common during the first year after transplantation (Fig 6). Some data suggest that the severity of early acute rejection episodes may influence the development of chronic rejection, the most common cause of graft failure in the late posttransplant period. Otherwise, the role of immunosuppression in treating and preventing chronic rejection is unclear. The discontinuation of immunosuppression by noncompliant patients is a major cause of late graft failure. Whether the nephrotoxicity of CsA will also result in graft failure in the very late posttransplant period is still unknown. The agents used to achieve immunosuppression, along with decreased graft function and proteinuria, contribute to hypercholesterolemia, hypertension, and hyperglycemia. These and other risk factors have a negative impact on both graft and patient survival. Thus, immunosuppression is directly, or indirectly linked to most of the common causes of death and graft failure after renal transplantation. Although potent new immunosuppression protocols have increased the rate of short-term patient and allograft survival after renal transplantation, future advances in long-term survival after renal transplantation will depend on improvements that are effective in the late posttransplant period. Currently, the best approach to preventing complications in the late posttransplant period is to maintain a vigilant, comprehensive program of on-going medical care. The minimal amount of immunosuppression required to prevent allograft rejection should be used, while adhering to the principle that it is better to lose the graft than to lose the patient.

Bacterial Infections↗
PubMed1991

Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome.

Treatment of early stage breast cancer with lumpectomy, axillary dissection, and radiation therapy is considered by many to be relatively contraindicated in heavy women or women with large or pendulous breasts. To quantitatively analyze this, we reviewed the cosmetic outcome in 257 patients. These patients were divided into "large" (89) and "average" (168) groups by one or more of the following criteria: weight greater than or equal to 80 kg, bra size greater than or equal to 40 in., cup size greater than or equal to D, and tangent separation greater than or equal to 23 cm. All patients were given cosmetic scores on a 1-10 scale by an independent observer for each of 8 cosmetic indices. These scores were analyzed at 1, 3, and 5 years follow-up (median 3 years). The average group scored higher than the large group on overall cosmesis (8.01 vs 7.34, p = 0.0004) and on 5 of 7 subindices (p = 0.0001 to 0.05) at 1 year. At 3 and 5 year follow-up only symmetry and retraction remained significantly different, favoring the average group. The largest difference noted at any point between the groups was 1.27 (retraction at 5 years, 8.54 vs 7.27, p = 0.0148). Therefore, although an inferior cosmetic result has been documented in the large group, we do not feel the magnitude of the difference mandates a change in our policy of offering all of these women breast-conserving therapy.

Adult↗
PubMed1991

Narcotic-induced histamine release: a comparison of morphine, oxymorphone, and fentanyl infusions.

This study, using an improved histamine assay, repeated previous studies that demonstrated large doses of morphine for induction of anesthesia in patients undergoing coronary artery bypass grafting were associated with histamine release. Thirty randomized patients received infusions of either morphine, 1 mg/kg, oxymorphone, 0.2 mg/kg, or fentanyl, 50 micrograms/kg, over a 10-minute period for induction of anesthesia prior to surgery. There were no significant changes in plasma histamine levels in individual patients or among drug groups. The discrepancy between the present histamine results and those previously reported using similar protocols is due, in part, to variations in plasma histamine measurements that can occur using the less reproducible, older assays for histamine. During routine inductions, large doses of morphine, oxymorphone, or fentanyl administered by infusion do not appear to stimulate release of clinically significant plasma levels of histamine.

Aged↗
PubMed1991

Arm edema in conservatively managed breast cancer: obesity is a major predictive factor.

To identify risk factors in the development of arm edema (AE) after conservative management of breast cancer, the authors prospectively measured differences in upper and lower arm circumference in 282 patients with stage I or II breast cancer who received radiation. AE was defined as a difference of 2.5 cm or more in either measurement between treated and untreated arms. Median follow-up was 37 months (range, 7-109 months). The crude frequency of AE overall was 19.5% (55 patients). In 21 patients (7.4%) AE was transient; 34 patients (12.1%) had persistent AE, which is the focus of this article. The 5-year actuarial incidence of persistent AE was 16%. The crude risk of persistent severe AE was 3.9%. Various factors were examined for their ability to enable prediction of AE. Treatment-related factors did not significantly enable prediction of AE, whereas factors related to patient size, such as body mass index, were strongly associated with both the frequency and severity of AE.

Adult↗
PubMed1990

Reversal of cranial nerve dysfunction with radiation therapy in adults with lymphoma and leukemia.

Twenty patients with leukemic (8) or lymphomatous (12) meningitis and cranial nerve palsies were treated with cranial irradiation at Memorial Sloan-Kettering Cancer Center from June 1987 through December 1988. The diagnosis of malignant meningitis was confirmed by malignant or 'suspicious' cerebrospinal fluid cytology in 13/20 patients. The 6th and 7th cranial nerves were most commonly involved. Multiple nerve involvement was present in 11/20 patients, for a total of 42 nerves affected. Treatment consisted of whole brain irradiation to a median dose of 2400 cGy (range: 1000-3000) at 200-300 cGy per fraction. Median survival was 7 months. Forty of 42 nerves improved, for an actuarial response rate of 95% at 3 months. The complete response rate was 44% and was better for patients with lymphoma than for those with leukemia (72% vs 19%, p = 0.04). Delaying initiation of irradiation more than 3 days after the onset of symptoms did not affect the ultimate response rate, but slightly increased the median time to response (9 days vs 14 days, p = 0.1). Radiation therapy is an effective means of reversing cranial nerve dysfunction in leukemia and lymphoma. Higher doses may be needed to increase the rate of complete response.

Adult↗
PubMed1989

Atypical mycobacterial infection of the gastrointestinal tract in AIDS patients.

This paper will describe a case series of 35 AIDS patients with infection of the gastrointestinal (GI) tract with Mycobacterium avium-intracellulare (MAIC). Thirty-five homosexual men with a mean age of 35 yr and a mean duration of AIDS of 7.7 months prior to the diagnosis of MAIC were investigated to determine the extent of MAIC infection. The investigations included upper endoscopy, sigmoidoscopy, liver biopsy, bone marrow aspiration and biopsy, stool and blood cultures for MAIC, and D-xylose absorption tests. Tissue biopsy material was examined by light microscopy with the Ziehl-Neelsen stain. The duodenum was most commonly involved (30/34 men), with 65% positive on special stains and 76% positive on culture of biopsy tissue. Unusual fine white nodules, believed to be characteristic for duodenal MAIC infection, were observed in 12 men. Esophageal (two men), liver (two men), and rectal involvement (seven men) were found. In nine of 18 men (50%), the D-xylose test was abnormal. In 28 of 33 men (85%), blood cultures grew MAIC. Similarly, in 25 of 28 men (89%), bone marrow biopsies grew MAIC, and in 18 of 21 men (86%) stool samples grew MAIC. We conclude that GI tract infection with MAIC in AIDS patients is frequently associated with systemic infection with the agent. Duodenal involvement is common, and may be accompanied by a characteristic gross lesion, that of fine white nodules on the mucosa. Malabsorption, as determined by the D-xylose test, is not a universal finding, as has been reported previously.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Acute arsenic toxicity--an opaque poison.

We report a patient with fatal acute arsenic poisoning presenting as vomiting and diarrhea with the finding of intra-abdominal radiopacities on radiographs. These represent the classic features of acute arsenic toxicity and are detailed here as a reminder to others facing a similar puzzling patient with this potentially treatable poisoning.

Abdomen↗
PubMed1987

The effects of intraoperative blood salvage and induced hypotension on transfusion requirements during spinal surgical procedures.

Spinal surgical procedures, such as placement of Harrington rods for correction of scoliosis, are associated with considerable perioperative blood loss and, hence, with the risks associated with homologous blood transfusions. To test the hypothesis that intraoperative autologous blood transfusions could decrease the amount of homologous blood needed in such operations, we conducted a two-part study: (1) a retrospective review of 142 patients in whom blood salvage was not used and (2) a prospective review of 28 patients who received autologous transfusions. Intraoperative autologous transfusion reduced the amount of homologous blood required by more than 50% (5.1 versus 2.0 units; P less than 0.001). The total amount of homologous blood required during the hospital stay was also significantly reduced by intraoperative autologous transfusion (6.0 versus 3.4 units; P less than 0.001). Induced hypotension in 81 of the 142 patients who did not receive autologous transfusions did not decrease the homologous blood transfusion requirements from those needed by the normotensive patients. We conclude that intraoperative autologous transfusion significantly reduces the need for homologous blood products in patients who undergo spinal surgical procedures. Induced hypotension, which did not affect transfusion requirements in our study, should be further evaluated in a blinded, prospective study.

Adult↗
PubMed1986

Intrathecal morphine for post-thoracotomy pain.

We wished to investigate possible differences in the duration of postoperative analgesia and the incidence of respiratory depression after the intrathecal injection in the lumbar area of 10 micrograms/kg morphine in hypobaric and hyperbaric solution for relief of post-thoracotomy pain. Twenty-nine patients received morphine plus dextrose (hyperbaric) and 21 received morphine in preservative-free normal saline. The duration of analgesia was longer with the morphine in the normal saline group than in the hyperbaric group (P less than 0.04). One patient developed delayed respiratory depression. Our data support the use of morphine in normal saline mixtures for greater duration of analgesia after thoracic operations.

Adolescent↗
PubMed1985

Design considerations for a fluorophotometer for ocular research.

Fluorometric studies have been made with modified slit-lamp microscopes. These instruments offered considerable versatility in modifying experimental parameters, but were seldom optimized in terms of detector and illuminator apertures, filter band-pass characteristics, detection system, light-source stabilization, or optical resolution. Improper control of these parameters can result in artifacts which override useful information. A new fluorophotometer for ocular research has been designed that utilizes an optical system, which eliminates the need for a contact lens. An effort was made to optimize both the axial resolution and the minimum detectable signal. The characteristics of standard barrier filters and excitation filters were examined and compared with photomultiplier sensitivity curves. It was necessary to use double filters in order to reduce artifacts due to excitation light that was not rejected by the barrier filter. In order to optimize the signal-to-noise ratio, a photon counting detection system was used. A dark current equivalent to 3 X 10(-10) g/ml allows a useful detection range of 1 X 10(-10) g/ml.

Anterior Chamber↗
PubMed1985

Optimized protocol for Fluorotron Master.

The technical aspects of fluorophotometry equipment are presented. The sources of artifact are described and a protocol to optimize the use of the "Coherent Fluorotron Master" system is presented. The results of fluorophotometry studies on ten patients indicate that more accurate data evaluation can be achieved using this approach.

Adult↗
PubMed1985

Characterization of the early stages of diabetic retinopathy by vitreous fluorophotometry.

We compared insulin-dependent diabetic patients with minimal (16 eyes of 9 patients) or no retinopathy (45 eyes of 27 patients) to normal volunteers (20 eyes of 12 subjects) using a commercial vitreous fluorophotometer and different procedures for artifact correction. The influence of background autofluorescence was minimized through the use of a software program that subtracted a fluorophotometric scan obtained before administration of fluorescein from that obtained after its injection. We also compared two programs designed to minimize the contribution of the chorioretinal peak spread function to the readings in the vitreous. The fluorescein concentration in the posterior vitreous was then averaged within two different regions. We then assessed the influence of these data-processing methods on the spread of the results of the different groups. The clinical study showed that only the posterior vitreous concentration of fluorescein is relevant in the evaluation of the blood-retinal barrier. However, since there is a gradient of fluorescein concentration in the posterior vitreous, one needs a scanning device so that one can measure at a precise location in front of the retina. The posterior vitreous concentration of fluorescein was significantly increased in diabetic subjects with one or no aneurysms as compared with normals. Moreover, the eyes with minimal retinopathy, as judged by the presence of microaneurysms, had higher values than those without retinopathy. The clear differences among these three groups were not present when the midvitreous values were used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗