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Biomedical subjects

R Grover

Publications and source records attributed to R Grover.

At least 55 records · Page 3Linked to original sources

Environmental fate of trifluralin.

Trifluralin, a preemergence, soil-applied and soil-incorporated herbicide, has been in agricultural use since 1963. The environmental chemistry and fate of dinitroaniline herbicides, including trifluralin, has been studied extensively in agricultural soils. Probst et al. (1975) and Helling (1976) have summarized pre-1975 data on the mobility, persistence, and degradation or metabolism of dinitroaniline herbicides as a group. Since then, numerous studies have been carried out on the fate of dinitroanilines, especially trifluralin, in the environment to understand further their degradation in soil, potential for mobility and persistence, and environmental concentration in water and air. The present review, while summarizing briefly earlier data, concentrates primarily on the post-1975 data on degradation, mobility, and persistence of trifluralin in soils and its potential concentrations in water and air. Trifluralin is readily degraded under sunlight in all media, with half-lives (t1/2) of minutes to several months, depending on the substrate. In addition, other dissipation processes, such as microbial and chemical, are also operative in soils, water, and sediments. Several degradation products of trifluralin have been identified and characterized, both under photolysis and following aerobic and anaerobic metabolism in soils and water-sediment systems. The differences between various degradative pathways of trifluralin appear to be more quantitative than qualitative in nature, leading eventually to the same end products that are subject to binding or mineralization with time. The general lack of accumulation of the breakdown products of trifluralin suggests that these are also subject to the same degradative mechanisms as the parent compound. Trifluralin has low water solubility and is strongly bound to soil components; mean Koc values range from 4,000 to 13,000. Once applied and incorporated into the soil, trifluralin remains relatively immobile with minimal or no potential for contamination of groundwaters under or near the treated zones. Trifluralin residues in soil surface layers are subject to loss via transport in runoff water or volatilization into the air. Seasonal losses in surface runoff are consistently less than 0.5% of the amounts applied, with concentrations in edge-of-the-field run-off water typically < 1.0 microgram L-1. Consequently, trifluralin is infrequently detected in surface waters and, if present, usually occurs below levels of quantification. Seasonal trifluralin losses into the atmosphere can be as high as 25% of that applied. Maximum trifluralin residues in the air above treated fields are in the 2-3 micrograms m-3 range following application, decreasing to < 100 ng m-3 in ambient air of intensive use areas, indicating its rapid dissipation in air. Trifluralin residues at < 100 pg m-3 in the atmosphere of remote nonuse regions have been reported, suggesting its potential for long-range transport. However, there is a general lack of understanding of the mechanisms controlling its potential for long-distance transport, especially considering its rapid photodegradation in vapor and solution states. The persistence of trifluralin in agricultural soils following incorporation is highly variable, depending on several factors such as depth of incorporation, soil moisture, soil temperature, soil air, and soil organic matter content. Estimated half-lives under a variety of agronomic conditions range from 25 to > 201 d, thus categorizing its persistence from 'moderate' to 'persistent'. The estimated half-life data for trifluralin under agronomic conditions, however, cannot be extrapolated to other potential scenarios, such as its dissipation in nontarget areas where trifluralin residues, if any, are essentially deposited on surfaces. Surface deposits on nontarget areas, unlike soil-incorporated residues, would be subject to volatilization and photolysis and thus more short lived. (ABSTRACT TRUNCATED)

Canada↗

The clinical significance of oncogene expression in subungual melanoma.

Subungual melanoma is a particularly aggressive tumour. However, biological investigations of its behaviour are presently lacking due to its comparative rarity. In order to study the biology of this disease, the activity of the c-myc oncogene was studied in tumours from 24 patients with subungual melanoma using the technique of flow cytometry. High levels of oncoprotein were found in all tumours and exceeded that documented in other varieties of cutaneous melanoma. Survival analysis revealed that stratification of patients according to oncogene activity provided a useful prognostic marker with shorter disease free interval (log rank test, chi 2 = 6.6, P = 0.01) and overall survival (log rank test, chi 2 = 3.6, P = 0.07) in tumours with high oncoprotein levels. This is the first study to investigate oncogene expression in subungual disease and supports its potential application as a prognostic marker.

Adult↗

Measurement of c-myc oncoprotein provides an independent prognostic marker for regional metastatic melanoma.

Patients with melanoma who develop nodal metastatic disease represent a group with heterogeneous clinical outcome. Nodal positivity remains the most accurate prognostic marker for regional melanoma although it fails to predict outcome in a significant number of patients. Recent studies have illustrated the prognostic potential of c-myc oncogene expression in melanoma. The aim of this study was to measure c-myc oncoprotein in a series of regional metastatic specimens from 48 patients, and evaluate its use as a marker of clinical outcome. Oncoprotein expression was detected in 46 (96%) of the tumours with a median positivity of 68% (range 0-98%). Survival analysis revealed a significant association between oncoprotein positivity and survival (Long-Rank test, chi 2 = 15.2, P < 0.001). Multivariate analysis of outcome showed c-myc oncoprotein to be an independent prognostic marker more accurate than all other clinicopathological parameters including nodal positivity (chi 2 = 8.34, P = 0.003). Estimation of c-myc oncoprotein is therefore recommended as a powerful prognostic marker for regional metastatic melanoma.

Aged↗

Clinical assessment of scaphoid injuries and the detection of fractures.

Difficulty in interpreting X-rays following carpal injury emphasizes the importance of clinical assessment in diagnosing scaphoid fractures. The classical sign of tenderness in the anatomical snuffbox is not specific and leads to many unnecessary out-patient reviews. A prospective comparison was made between anatomical snuffbox, scaphoid tubercle and scaphoid compression tenderness as indicators of scaphoid fracture in 221 patients with suspected scaphoid injury. Swelling was determined by measuring the difference in circumference at the wrist joint to compare between fracture and soft tissue injury. Scaphoid compression tenderness was found to be the most accurate test with a sensitivity of 100% and a specificity of 80%. Swelling of the wrist joint was significantly greater when there was a fracture, compared to soft tissue injury alone, even when the initial X-ray was normal. This was independent of any physiological variation in circumference between dominant and non-dominant sides. Scaphoid compression tenderness is therefore suggested as the most accurate indicator of scaphoid fracture and marked swelling should raise suspicion even if the X-ray is normal.

Adolescent↗

Management of hypopigmentation following burn injury.

Hypopigmentation is a troublesome often permanent sequelae following burn injury, particularly in dark races. A number of methods have been described to treat this phenomenon ranging from primary closure, split skin and particulate grafting as well as semipermanent and permanent camouflage. This article reviews the pathophysiology of this condition and discusses the indications for using each technique as well as the potential for future developments in melanocyte culture.

Burns↗

C-myc oncogene expression in human melanoma and its relationship with tumour antigenicity.

Melanoma produces specific tumour antigens which are capable of eliciting an immune response. However, this tumour evades the immune system, in part, by downregulation of class I HLA antigens on the cell surface, which are required for T cell recognition. It has been suggested that the oncogene c-myc may have a role in effecting this change in vitro, however, the relationship between oncoprotein level and tumour antigenicity has not been established in human tumours. This study measured c-myc oncoprotein in 94 melanoma specimens (46 primary tumours and 48 regional metastases) using flow cytometry and evaluated class I HLA expression with immunohistochemistry. C-myc expression was found in 91 tumours (96%) with higher expression in metastases than primary melanomas (P<0.005). Class I HLA expression was found to show great variation although metastases showed less antigenicity than primary tumours (P<0.01). Analysis of the relationship between these two parameters revealed a highly significant correlation in both primary (P<0.01) and metastatic disease (P<0.01), with high oncoprotein being associated with down regulation of cell surface antigens. Knowledge of the control of tumour antigenicity is likely to provide an objective platform for the development of new strategies for immunotherapy.

Antigens, Neoplasm↗

Bcl-2 expression in malignant melanoma and its prognostic significance.

Programmed cell death (apoptosis) is now recognized as an important factor in tumour growth. Bcl-2 is an oncogene which promotes tumour progression by specifically inhibiting programmed cell death. Bcl-2 oncoprotein was measured using flow cytometry in 42 surgically excised regional lymph node metastases from patients with a median follow-up of 45 months. Fifteen patients in the study were found to have bcl-2 expression which was associated with significantly shorter survival (log-rank test, P<0.002). In addition, multivariate analysis confirmed the predictive value of bcl-2 independent of other established prognostic markers (chi(2)=7.02, P<0.01). Oncogenic control of programmed cell death is therefore important in melanoma progression and bcl-2 measurement provides a useful marker of prognosis for regional lymph node metastases.

Biomarkers, Tumor↗

Improving the early detection of malignant melanoma.

The early detection of cutaneous melanoma is known to be associated with reduced mortality. In order to improve early detection of suspicious skin lesions a Pigmented Lesion Clinic (PLC) was set up at Mount Vernon Hospital in January 1993. Its aims were to provide a rapid method of expert assessment and treatment for malignant skin tumours as well as reassurance for patients with benign lesions. In the first 2 years, 1779 new patients were seen and 674 lesions excised, of which 18% were malignant. Comparison of the Breslow thicknesses of melanomas diagnosed via the PLC revealed a significant shift towards thinner early tumours when compared with the two previous years (chi 2 = 12.8, P < 0.01) and during the same time period via normal routes of referral (chi 2 = 8.68, P < 0.02). The running of such a service and its hidden benefits are discussed.

England↗

Clinical events in the first decade in a cohort of infants with sickle cell disease. Cooperative Study of Sickle Cell Disease.

Within the Cooperative Study of Sickle Cell Disease, 694 infants with confirmed sickle cell disease were enrolled at less than 6 months of age. Information about the nature and frequency of complications was collected prospectively over a 10-year period. Painful crises and acute chest syndrome were the most common sickle cell-related events in homozygous sickle cell anemia (SS), hemoglobin SC disease (SC), and S beta thalassemia patients (overall incidence in SS patients of 32.4 and 24.5 cases per 100 person-years, respectively). Bacteremia occurred most frequently in SS children under 4 years of age and in SC patients less than 2 years of age. The mortality rate was low in this cohort compared with that found in previous reports. Twenty children, all with Hb SS, died (1.1 deaths per 100 person-years among SS patients). Infection, most commonly with Streptococcus pneumoniae and Hemophilus influenzae, caused 11 deaths. Two children died of splenic sequestration, 1 of cerebrovascular accident, and 6 of unclear causes. Two patients underwent cholecystectomies, and 17 underwent splenectomies after one or more splenic sequestration crises. The experience of this cohort should reflect closely the true clinical course of those children with Hb SS and Hb SC disease who are observed in sickle cell centers in the United States.

Anemia, Sickle Cell↗

Conservative management of an ovarian polyembryoma.

BACKGROUND: Polyembryomas are rare, immature germ cell malignancies characterized by numerous embryo-like bodies in association with mature and immature teratoma structures and primitive embryonic tissue. The purpose of this paper is to present a patient in whom surgical staging and postoperative serial tumor markers and imaging studies were used to determine management. CASE: A 43-year-old woman with a stage IA polyembryoma was followed with serial alpha-fetoprotein and hCG assays, as well as serial abdominal and pelvic computed tomography (CT) scans, following surgical staging and a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Chemotherapy was not given because the patient's tumor markers declined steadily into the normal range and imaging studies revealed no evidence of recurrent disease. CONCLUSION: Women with polyembryomas surgically staged and confined to one ovary may be followed with serial tumor markers and diagnostic imaging techniques to avoid aggressive cytotoxic chemotherapy.

Adult↗

Tuberculosis in human immunodeficiency virus-infected children. A family infection.

OBJECTIVE: To study the epidemiologic and clinical features of infection with Mycobacterium tuberculosis in human immunodeficiency virus (HIV)-infected children and their families. PATIENTS AND CLINICAL SETTING: Sixty families of children with HIV infection, children of HIV indeterminate status, and seroreverters underwent follow-up in a comprehensive multidisciplinary program for children and families. METHODS: Infection with M tuberculosis was diagnosed based on a positive Mantoux test result or a positive culture. RESULTS: Mycobacterium tuberculosis infection was diagnosed in seven children (three infected with HIV, three seroreverters, and one uninfected sibling of an infected child) from four families (6%). All infections were detected in the period from March 1990 through January 1992. Six of seven children had a history of exposure to M tuberculosis in an HIV-infected adult (parent) who was an intravenous drug user, homeless, and/or noncompliant with the medical regimen. All HIV-infected children and one seroreverter had pulmonary tuberculosis. One child died of complications of tuberculosis and HIV infection. The M tuberculosis isolated from this child was resistant to isoniazid, rifampin, and streptomycin sulfate. CONCLUSIONS: Tuberculosis is a growing problem among inner-city children born to HIV-infected parents. Children infected with HIV in this study had symptomatic and severe disease with tuberculosis, which reflected the drug susceptibility pattern of M tuberculosis seen in our community.

AIDS-Related Opportunistic Infections↗

Method for diagnosing rejection in small bowel transplantation.

Diagnosis of rejection in small bowel transplantation by the identification of a host-cell infiltrate is hampered by the physiological trafficking of host lymphocytes to the 'gut-associated lymphoid tissue' of the graft. This study compared physiological host-cell infiltration of small bowel grafts with that occurring in rejection and stable immunosuppression. Physiological host-cell infiltration, where the graft does not present an immune stimulus to the host, was assessed by transplanting bowel from DA to (DA x PVG) F1 hybrid rats. The extent of host-cell infiltration was determined by immunohistochemical analysis. In the lamina propria, considerable infiltration by host cells was seen, although it was significantly less than that in rejection or stable immunosuppression. By contrast, host cells were seen in the intraepithelial compartment only in rejection. Host-cell infiltration in the absence of an allogeneic stimulus suggests that histological identification of host cells in the lamina propria is not necessarily indicative of rejection. However, the presence of host cells in the intraepithelial compartment is specific for rejection in small bowel transplantation.

Animals↗

Developmental screening in young children with sickle cell disease. Results of a cooperative study.

PURPOSE: The goal of the study was to assess development in young children with sickle cell disease as part of the Cooperative Study of Sickle Cell Disease (CSSCD). PATIENTS AND METHODS: The Denver Developmental Screening Test (DDST) was administered to children younger than 6 years at 12 participating institutions of the CSSCD. Trained examiners administered tests to 344 children. RESULTS: Tests were scored as normal in 90.4%, questionable in 6.4%, and abnormal in 1.5%; 1.7% of children were considered untestable. There was no relationship between DDST results and sickle cell genotype. Questionable and abnormal (Q/A) scores were more common in children ages 3-5 years than in younger children (12.6% versus 3.8%; P = 0.002). CONCLUSIONS: Because the DDST is a screening test, it should be interpreted cautiously. However, the more numerous Q/A scores in our "older" group agree with the findings of recent reports of neuropsychological impairment in school-age children with sickle cell disease. Our data suggest that development is relatively normal before age 3 years; deficits seen in older children may reflect subsequent ischemic insults.

Age Factors↗