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Biomedical subjects

M E Vincent

Publications and source records attributed to M E Vincent.

At least 19 recordsLinked to original sources
PubMed1997

Teleradiology for remote diagnosis: a prospective multi-year evaluation.

Teleradiology has been used for nearly 3 years at our institution to provide urgent radiologic interpretations for two outpatient clinics and an affiliated hospital. The purpose of this study was to evaluate the clinical reliability of the existing system. Teleradiology images were interpreted using 1600 x 1200 pixel display stations. The original films from the same cases were subsequently interpreted, usually by another radiologist. The initial and final interpretations were compared. Discrepancies were rated and adjudicated by another senior radiologist. These data were compared to peer review interobserver discrepancy rates. Among the 2688 teleradiology examinations evaluated, there were major discrepancies in 31 (1.5%). In three instances teleradiology rather than film interpretation was considered correct. Abnormalities missed on teleradiology were apparent in all but two at adjudication. Among the 628 peer-review cases, there were 6 (0.96%) major discrepancies. Major teleradiology discrepancy rates are statistically similar to film-based peer review discrepancy rates. Teleradiology is suitable for providing radiologic services to remote medical facilities.

Evaluation Studies as Topic↗
PubMed1995

Characterization of a putative molluscan insulin-related peptide receptor.

In the pond snail Lymnaea stagnalis (Ls), growth and associated processes are likely to be controlled by a family of molluscan insulin-related peptides (MIP). Here we report on the cloning of a cDNA encoding a putative receptor for these MIP. This cDNA was isolated from Ls via PCR with degenerate oligodeoxynucleotides corresponding to conserved parts of the tyrosine kinase domain of the human insulin receptor and its Drosophila homologue. Many of the typical insulin-receptor features, including a cysteine-rich domain, a single transmembrane domain and a tyrosine-kinase domain are conserved in the predicted, 1607-amino acid (aa) protein. Comparison of the aa sequence of the molluscan receptor to other insulin-receptor sequences revealed strong variations in the percentage of sequence identity for the different domains, ranging from 70% sequence identity in the tyrosine-kinase domain to virtually no sequence identity in the C-terminal sequence. Striking differences are the absence of a clear tetrabasic cleavage site, and the extremely long C-terminus of 308 aa that contains seven Tyr residues. Southern blot analyses at varying stringencies, extensive screening of cDNA- and genomic libraries, and PCR experiments indicate the presence of a single putative MIP receptor. This suggests that the four different MIP may exert their functional role in Ls by binding to the same receptor.

Amino Acid Sequence↗
PubMed1994

Phase I trial of intravenous and intraperitoneal administration of granulocyte-macrophage colony-stimulating factor.

To assess the toxicity, pharmacokinetics, and local and systemic effects of the intraperitoneal (i.p.) administration of granulocyte-macrophage colony-stimulating factor (GM-CSF) at various dosages, 13 patients with predominantly i.p. malignancies refractory to standard chemotherapy were studied. GM-CSF was administered intravenously (i.v.) for 5 consecutive days; 21 days later the same dosage of GM-CSF was administered i.p. for 5 consecutive days. Four dosage levels were studied: 1, 2, 4, and 8 micrograms/kg/day. GM-CSF was well tolerated after i.v. and i.p. administration at doses up to 8 micrograms/kg/day. A transient fall followed by an elevation of circulating white cells was observed over a 24-h period after both i.v. and i.p. GM-CSF administration (mean minimum +/- SE as % baseline): 38 +/- 8% at 30 min after i.v. administration, 21 +/- 5% at 60 min after i.p. administration; mean maximum: 220 +/- 41% at 6 h after i.v. administration, 202 +/- 39% at 12 h after i.p. administration). The magnitude and time course of these changes were very similar for the two routes despite an up to 400-fold difference in serum GM-CSF levels at the same time points. Changes in leukocyte count and differential and neutrophil function were also similar over the 3-week period after both i.v. and i.p. administration. In the only patient who had i.p. GM-CSF levels assayed, i.p. administration achieved high levels of GM-CSF in peritoneal fluid (Cmax 343 ng/ml) with maintenance of high concentrations over 24 h (C24h 128 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

A model for multidisciplinary data collection for cervical metastasis.

A system for multidisciplinary data collection for metastatic neck disease is discussed. Information from 87 neck dissections and 3218 lymph nodes is reported to illustrate the strength of the model. Clinical (endoscopic) assessment under general anesthesia, surgical assessment during the neck dissection, and radiographic (computed tomographic scan) assessment were compared with the pathological evaluation. All disciplines stratified the necks by region and node size. This model provides an effective stratagem for multi-institutional studies.

Data Collection↗
PubMed1990

Esophagography and esophagoscopy. Comparison in the examination of patients with head and neck carcinoma.

We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.

Adult↗
PubMed1988

Radiology reports: assessment of a 5,000-word speech recognizer.

A prototype 5,000-word recognizer for the generation of radiologic reports by voice entry was evaluated. The system had a capacity sufficient enough to include all radiologic examinations and all desired words in one lexicon. The lack of such a capacity had been identified as a major limitation of a 1,000-word system previously evaluated. Overall reliability in word recognition was 98%. The device may be widely applicable for use in any radiology practice.

Hospital Information Systems↗
PubMed1987

Tumor regression and temporary restoration of immune response after plasmapheresis in a patient with recurrent oral cancer.

A major response to plasmapheresis is reported in a patient with advanced, recurrent squamous cell cancer of the oral cavity, similar to that previously reported in three of six comparable patients. Tumor regression followed temporary reduction of inhibition of normal lymphocyte response to phytohemagglutinin (PHA) by the patient's serum (from 99% to zero) and partial restoration of the patient's lymphocyte response (from 2% to 38% of control). The IgE level rose both overall and during some exchanges; this correlate of tumor response had been noted earlier. The tumor showed extensive necrosis, but the clinical effects were relatively short-lived and the patient died 11 weeks later. Biopsy specimens taken early in apheresis showed intense new infiltration of tumor by lymphocytes and monocytes; later biopsy specimens showed predominantly plasma cells with trapping and lysis of tumor cells. No other anti-cancer therapies had been used for 16 months before this trial, and no replacements were given other than saline and albumin.

Antigens, Surface↗
PubMed1987

Speech-controlled generation of radiology reports.

Voice entry has been successfully employed to generate radiology reports with a word recognizer with a 1,000-word lexicon capacity. About 50% of reports were able to be dictated with a single 900-word lexicon. This was split into five sections by anatomic or subspecialty application. Each was augmented to 900 words. By switching from one lexicon to another, it was possible to dictate more than 70% of reports. With exclusive use of three lexicons in subspecialty areas (gastrointestinal radiology, neuroradiology, and mammography), and with further modification of the respective vocabulary, it has been possible to employ the system 88% of the time. Twelve percent of cases included wording that was beyond the scope of the lexicon. Computer subsets that allow different translations of some words when used in different contexts have been used. Some of these are used as triggers that will print whole lines, sentences, or even complete reports. Dictation times with voice entry take about 20% longer. Recognition reliability has been greater than 95%.

Computers↗
PubMed1986

Effect of single doses of labetalol, metoprolol, and placebo on ventilatory function in patients with bronchial asthma: interaction with isoproterenol.

The effects of labetalol, metoprolol, and placebo on pulmonary function and their interaction with isoproterenol were evaluated in 18 patients with reversible bronchial asthma [isoproterenol-induced increase in forced expiratory volume in 1 second (FEV1) of greater than or equal to 15%]. Two dose levels of each medication were studied (on consecutive days), with the lower doses of these drugs given randomly. When the lowest values during the 2-hour postdrug evaluation period were considered, FEV1 significantly increased (10.9%; 15.4%) following labetalol (200 and 400 mg, respectively), significantly decreased (-11.2%; -5.4%) after metoprolol (100 and 200 mg, respectively), and was unchanged after placebo. The effects of the three treatments on forced vital capacity (FVC) and maximal midexpiratory flow (MMEF) were qualitatively similar to those observed in FEV1. When isoproterenol was administered following labetalol (200 and 400 mg), FEV1 further increased with a resulting combined increase of 18.9 and 19.7%, respectively, indicating an additive interaction. The effect of isoproterenol was blunted by metoprolol (100 and 200 mg) (p less than 0.01, difference from the effect observed after labetalol and isoproterenol), indicating antagonistic interaction between these two drugs. Labetalol may be a safer antihypertensive than metoprolol in patients with concomitant bronchial asthma.

Adult↗
PubMed1984

Esophageal invasion by lung cancer: CT diagnosis.

Esophageal wall invasion by primary lung carcinoma is an uncommon occurrence. When CT demonstrates a large primary parenchymal lung lesion that appears to cross the midline in the posterior mediastinum, dilute oral barium should be given during the CT examination to demonstrate the location of the esophagus. An esophagus involved by lung carcinoma may show contralateral displacement or partial obstruction. Furthermore, a malignant fistula between esophagus and trachea or lung may also be discovered.

Aged↗
PubMed1984

The reticular pattern as a radiographic sign of the Barrett esophagus: an assessment.

A two-part retrospective study was conducted to assess the value of a reticular pattern as a sign of columnar-lined esophagus. Radiographic, endoscopic, and histologic findings were reviewed in 124 patients with known Barrett esophagus; then all barium esophagrams done at our institution during a 3 1/2 month period were reviewed and presence of a reticular pattern was correlated with available endoscopic and histologic data. In patients with known Barrett esophagus, the reticular pattern was found in 26% of double-contrast examinations. Twelve of these patients underwent careful esophageal mapping biopsies: the pattern was in squamous mucosa with ulceration in two, in columnar epithelium with ulceration in six, and in columnar epithelium without ulceration in four. In the group of 314 unselected patients who had double-contrast examinations, the reticular pattern was found in 26 (8%). Thirteen of the 26 had had endoscopy and biopsy: the site of the pattern was located in a squamous carcinoma in one, in squamous epithelium adjacent to squamous carcinoma in three, in squamous epithelium with esophagitis in five (two of whom had columnar mucosa distally), in normal squamous mucosa in one, and in columnar epithelium with esophagitis in three. The reticular pattern is a strong indicator of important esophageal disease, but is not specific for Barrett esophagus.

Barrett Esophagus↗
PubMed1984

Evaluation of Blom-Singer voice prosthesis.

Tracheoesophageal puncture and use of a silicone prosthesis is becoming a common and highly effective procedure for voice rehabilitation in the alaryngeal patient. Radiologic evaluations were reviewed of 31 patients scheduled for tracheoesophageal puncture at this institution over the past 3 years. Barium swallow examinations were performed preoperatively to assess anatomy and muscular activity of the pharyngoesophagus. Examinations were performed postoperatively when complications were suspected, phonation was unsatisfactory, or as routine oncologic follow-up. Postoperative complications included neck abscess, cervical osteomyelitis, and feeding tube dissection into the anterior wall of the thoracic esophagus. This method of pre- and postoperative radiologic evaluation of these patients is presented, along with the radiologic manifestations of the complications.

Aged↗
PubMed1984

Hemodynamic and humoral responses to enalapril and nifedipine in the rat.

The hemodynamic and humoral effects of enalapril, an angiotensin converting enzyme (ACE) inhibitor, and nifedipine, a calcium-entry blocker, were evaluated in conscious spontaneously hypertensive rats (SHR). Rats received enalapril (5 mg/kg, po) or vehicle, followed in one hour by nifedipine (2.5 mg/kg, ip) or its vehicle. After treatment with enalapril alone, systolic blood pressure (BP) declined over a 3 hour period from 204 +/- 4 (mean +/- SE) to 168 +/- 6 mm Hg and remained suppressed for an additional 4 hours. Heart rate (HR) did not change. Plasma renin activity (PRA) increased approximately 9-fold and serum ACE was maximally inhibited. BP response to nifedipine was more rapid, greater in magnitude (-59 +/- 6 mm Hg) and shorter in duration; heart rate increased and remained elevated for 2.5 hours. PRA only rose two-fold. After the drugs in combination, BP declined as rapidly and to the same degree as after nifedipine and remained reduced for a longer duration. Treatment with enalapril attenuated the reflex tachycardia observed after nifedipine. These data suggest that coadministration of an ACE inhibitor and calcium-entry blocker may provide better blood pressure control than either drug class alone and at the same time prevent the reflex tachycardia frequently observed after nifedipine.

Animals↗
PubMed1984

Adenocarcinoma and Barrett's esophagus. An overrated risk?

The risk of developing esophageal cancer in Barrett's esophagus has been estimated at about 10%. This estimate is based primarily on data concerning the prevalence of that association in series of hospitalized patients and autopsies--a practice that tends to exaggerate the risk. We have reviewed retrospectively our experience with 115 patients whom we treated for Barrett's esophagus between September 1962 and March 1983, and have distinguished our data on the prevalence of esophageal cancer from that on incidence. For 8 patients, we found both Barrett's esophagus and esophageal adenocarcinoma during the initial evaluations for a prevalence ratio of 7%. We followed 105 patients not found to have esophageal cancer initially for a total of 350 person-years. Only 2 patients developed adenocarcinoma during that follow-up period for an incidence of 1 case per 175 person-years. This incidence, although some 40-fold greater than that of the general population, is substantially lower than previously estimated. Routine endoscopic and histologic surveillance has been recommended for patients with Barrett's esophagus because of the alleged high incidence of esophageal cancer. Inasmuch as that incidence now appears to be low, we question the value of such surveillance for these patients.

Adenocarcinoma↗