Anaerobic infection of the lumbar spine in an intravenous drug abuser.
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Adult↗
Biomedical subjects
R J Gibson
Publications and source records attributed to R J Gibson.
Outcome, observer reliability, and patient preferences if CTA, MRA, or Doppler ultrasound were used, individually or together, instead of digital subtraction angiography before carotid endarterectomy.
OBJECTIVES: To evaluate the accuracy of routinely available non-invasive tests (spiral computed tomographic angiography (CTA), time of flight magnetic resonance angiography (MRA), and colour Doppler ultrasound (DUS)), individually and together, compared with intra-arterial digital subtraction angiography (DSA) in patients with symptomatic tight carotid stenosis; and to assess the effect of substituting non-invasive tests for DSA on outcome, interobserver variability, and patient preference. METHODS: Patients referred from a neurovascular clinic were subjected prospectively to DUS imaging. The operator was blind to symptoms. Patients with a tight carotid stenosis on the symptomatic side were admitted for DSA. CTA and MRA were performed during the admission. The CTA, MRA, and DSA films were each read independently by two of six experienced radiologists, blind to all other data. RESULTS: 67 patients were included (34 had all four imaging procedures). DUS, CTA, and MRA all agreed with DSA in the diagnosis of operable v non-operable disease in about 80% of patients. CTA tended to underestimate (sensitivity 0.65, specificity 1.0), MRA to overestimate (sensitivity 1.0, specificity 0.57), and DUS to agree most closely with (sensitivity 0.85, specificity 0.71) the degree of stenosis as shown by DSA. When using any two of the three non-invasive tests in combination, adding the third if the first two disagreed would result in very few misdiagnoses (about 6%). MRA had similar interobserver variability to CTA (both worse than DSA). Patients preferred CTA over MRA and DSA. CONCLUSIONS: DUS, CTA, and MRA all show similar accuracy in the diagnosis of symptomatic carotid stenosis. No technique on its own is accurate enough to replace DSA. Two non-invasive techniques in combination, and adding a third if the first two disagree, appears more accurate, but may still result in diagnostic errors.
Carotid Stenosis↗
Erectile dysfunction induced by orthopedic trauma managed with a fracture table.
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Erectile Dysfunction↗
Magnetic resonance imaging in acute non-accidental head injury.
Making the diagnosis of non-accidental head injury, particularly in the acute illness, can be difficult. The aim of this retrospective study was to evaluate the use of magnetic resonance imaging in the acute presentation of non-accidental head injury. Twelve cases admitted to the Royal Hospital for Sick Children, Edinburgh with a diagnosis of non-accidental head injury, and who had magnetic resonance imaging in the acute illness, were identified. The average age was 5.7 mo (range 1 to 34 mo). The mechanism of the primary injury was whiplash-shaking injury syndrome with impact in four cases and without evidence of impact in seven; in one case there was a compression injury. The magnetic resonance imaging findings reflected the pathological consequences of rotational acceleration-deceleration injury and did not differ between those cases with evidence of impact and those without. Subdural haematomas were identified in all cases; the commonest location for subdural blood was the subtemporal region. It is surprising and important that the most frequent location of subdural blood was in the subtemporal area. This is an area difficult to assess by computerized tomography. Evidence of repeated injuries was found in two cases. These findings confirm the value of magnetic resonance imaging in the acute phase of non-accidental head injury.
Acute Disease↗
The effect of angiographic technique and image quality on the reproducibility of measurement of carotid stenosis and assessment of plaque surface morphology.
We studied the reproducibility of measurement of carotid stenosis and assessment of plaque surface morphology on 1001 angiograms from a consecutive series of patients entered into the European Carotid Surgery Trial. Inter-observer agreement (Kappa statistic, 95% confidence interval (CI)) for categorization of carotid stenosis, as 0-29%, 30-69% or 70-99% was good (0.68, 0.63-0.73) on 789 conventional or digitally subtracted selective angiograms, and good (0.64, 0.54-0.75) on 174 conventionally and digitally subtracted aortic arch injection angiograms, but was poor (0.29, 0.02-0.80) on 29 intravenous digital subtraction angiograms. Inter-observer agreement did not vary with the method of image acquisition of arterial angiograms, but was dependent on the quality of visualization of the stenosis: kappa = 0.73 (0.67-0.79) for good quality angiograms vs. 0.54 (0.44-0.64) for poor quality angiograms. Inter-observer agreement for assessment of plaque surface morphology was moderate (kappa 0.4-0.6) and did not vary with type of angiography or method of image acquisition. However, ulceration was reported most frequently on selective angiograms and on those angiograms on which the quality of visualization of the stenosis was good. We conclude that the reproducibility of measurement of carotid stenosis and the assessment of plaque surface morphology vary depending on the type of angiography and the quality of visualization of the stenosis. This should be taken into account when validating non-invasive methods of imaging the carotid bifurcation.
Aged↗
Further observations of the ovarian response of the tammar wallaby (Macropus eugenii) to exogenous gonadotrophins: an improved method for superovulation using FSH/LH.
This study reports the development of an improved superovulation protocol in the monovulatory tammar wallaby, Macropus eugenii. Treatment with pregnant mare's serum gonadotrophin (PMSG; 10-20 IU) inhibited follicle development in the corpus luteum (CL)-bearing ovary and only 2-3 eggs per female could be recovered after ovulation induction with gonadotrophin releasing hormone (GnRH; 3 x 30 microg at 3-h intervals) or porcine luteinizing hormone (LH; 4, 5 or 8 mg) 3 days after PMSG priming. Treatment with porcine FSH (8 x 6 mg at 12-h intervals for four consecutive days) was found to override this inhibition and resulted in the recovery of 7-13 eggs per female after ovulation induction with porcine LH (4 mg on day 5). For these animals, there was no difference in numbers of developing follicles, ovulation sites and eggs recovered between the CL- and non-CL-bearing ovaries. This FSH/LH protocol was effective in both cycling and non-cycling females, and multiple ovulation occurred from about 36 h after LH treatment. After LH treatment, eggs were recovered from the oviduct at 36-50 h. At 51-57 h, 12-25% of eggs were recovered from the uterus, and by 75 h all eggs were recovered from the uterus. It is concluded that the described FSH/LH protocol used results in higher ovulation success than the PMSG/GnRH method.
Animals↗
Aggressive behaviour in intellectually challenged patients with epilepsy treated with lamotrigine.
PURPOSE: Lamotrigine (LTG) is a valuable addition to the medical management of epilepsy with wide spectrum of efficacy and good outcomes for quality of life. We report the emergence of a syndrome of aggressive behavior provoked by LTG in patients with epilepsy and intellectual challenge. METHODS: On recognition of a tendency to aggression in intellectually challenged patients whose epilepsy was treated with LTG, a survey was conducted of those from centers specializing in management of patients with intellectual disability who were treated with LTG. Responses to LTG were sought and patient's behavioral profiles were determined. RESULTS: Nineteen patients were identified (16 men, 3 women, aged 17-54 years). Five patients discontinued LTG due to unprovoked aggressive behavior subsequent to its use; 2 had aggressive behavior sufficient to justify discontinuation of LTG but required reintroduction to control the epilepsy; 1 required reduction in LTG dosage; 1 had aggression that responded to psychiatric intervention; and 1 had aggression unrelated to LTG. Four patients had behavioral problems other than aggression, 4 had no change in behavior, and the behavior of 1 was improved by LTG treatment. CONCLUSIONS: LTG may provoke aggressive behavior and violence in intellectually handicapped patients with epilepsy, which may limit its use in such patients. Acknowledgment of the potential for such disturbance justifies greater surveillance of these patients and early discontinuation of LTG if necessary.
Adolescent↗
Successful fertilization after superovulation and laparoscopic intrauterine insemination of the brushtail possum, Trichosurus vulpecula, and tammar wallaby, Macropus eugenii.
Fertilization has been achieved in superovulated brushtail possums and tammar wallabies after laparoscopic intrauterine artificial insemination. Various superovulation protocols and insemination times were examined but a maximum of 2-5 eggs including 1-2 embryos per possum were recovered. The female possums were superovulated by treatment with 15 iu pregnant mares' serum gonadotrophin and then either GnRH (4 x 50 micrograms, at intervals of 90 min) or 4 mg LH, 3 days later. Inseminations were performed within 6 h before or 4-10 h after (pregnant mares' serum gonadotrophin-GnRH group only) the expected onset of ovulation using epididymal spermatozoa. Superovulation in wallabies was achieved by treatment with FSH (8 x 6 mg, at intervals of 12 h for 4 days) followed by 4 mg LH on day 5. Inseminations were performed 4-6 h before the expected onset of ovulation using ejaculated spermatozoa, which resulted in the recovery of 7-8 eggs including 3-4 embryos per female. All embryos recovered were from possums and wallabies examined 1-2 days after insemination and included fertilized eggs, two-cell and four-cell embryos. Motile spermatozoa were recovered from the oviducts and uteri but only immotile spermatozoa were found in the vaginal complex. Five to thirty per cent of spermatozoa recovered from the oviducts of possums examined 2-6 h after insemination had thumbtack morphology, which is thought to be correlated with capacitation. Although embryo yields per female were low, this study has established that intrauterine artificial insemination after superovulation is a feasible assisted breeding strategy for marsupials with implications for species conservation and population control.
Animals↗
Computed tomographic evidence of cerebral swelling in benign intracranial hypertension.
Computed tomography of 30 patients presenting acutely with benign intracranial hypertension was compared with that of 30 normal controls matched for age and sex. Qualitative and quantitative assessments showed smaller cranial CSF spaces in the cases of benign intracranial hypertension, suggesting that cerebral swelling is involved in the pathogenesis of benign intracranial hypertension.
Brain↗
Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group.
BACKGROUND AND PURPOSE: There is confusion about how carotid stenosis should be measured on angiograms. If the results of research based on different methods of measurement of stenosis are to be discussed and the results of clinical trials properly applied to routine clinical practice, measurements made by the different methods must be formally compared. METHODS: The method of measurement of stenosis used in the European Carotid Surgery Trial (ECST), that used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and a method based on measurement of the common carotid (CC) artery lumen diameter were compared. Carotid stenosis was measured by two observers, working independently and using the three different methods of measurement, on the angiographic view of the symptomatic carotid stenosis that showed the most severe disease in 1001 patients from the ECST. RESULTS: The results of using the ECST and CC methods differed from those of using the NASCET method in the classification of stenoses as mild (0% to 29%), moderate (30% to 69%), or severe (70% to 99%) in 51% of measurements. The ECST and CC methods indicated that twice as many stenoses were severe as did the NASCET method, and classified less than a third of the number of stenoses as mild. The results of the ECST and CC methods differed from each other in 15% of measurements. The relations between measurements made by each method to those made by the others were approximately linear, so a simple equation could be derived to convert measurements made by one method to measurements made by the others. CONCLUSIONS: There were major and clinically important disparities between measurements of stenosis made using different methods of measurement on the same angiograms. However, it is possible to convert measurements made by one method to those of another using a simple arithmetic equation.
Angiography↗
Prognostic value and reproducibility of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group.
BACKGROUND AND PURPOSE: The use of three methods of measuring carotid stenosis, which produce different values on the same angiograms, has caused confusion and reduced the generalizability of the results of research. If the results of future studies are to be properly applied to clinical practice, and if noninvasive methods of imaging are to be properly validated against angiography, a single, standard method of measurement of stenosis on angiograms must be adopted. This standard method should be selected on the bases of its ability to predict risk of ipsilateral carotid distribution ischemic stroke and its reproducibility. METHODS: The method of measurement of carotid stenosis used in the European Carotid Surgery Trial (ECST), that used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and a method based on the measurement of the common carotid (CC) lumen diameter were studied. Their use in the prediction of ipsilateral carotid distribution ischemic stroke was assessed in 1001 consecutively selected patients randomly assigned to medical treatment in the ECST. Carotid stenosis was measured by two observers working independently, using all three methods, on the angiographic view that showed the most severe stenosis of the symptomatic carotid bifurcation. Interobserver agreement was determined, and 50 angiograms were remeasured to determine intraobserver agreement. RESULTS: There was little difference in the ability of the three methods to predict ipsilateral carotid distribution ischemic stroke. The CC method was consistently the most reproducible of the three, particularly for stenosis in the clinically important range of 50% to 90%. CONCLUSIONS: The CC method of measurement should be adopted as the standard method of measuring the degree of carotid stenosis on angiograms.
Angiography↗
An assessment of Gd-DTPA as a CT contrast agent in the renal tract.
Intravenous gadolinium diethylene triamine penta-acetic acid (Gadopentetate dimeglumine, Gd-DTPA) is visualized as a radiographic contrast agent in the renal tract on computed tomography (CT). In this study the CT appearance of this contrast agent within the renal collecting systems of 12 patients is described following a Gd-DTPA enhanced magnetic resonance imaging (MRI) study. The CT appearances are variable and not predictable on the basis of time from injection, age, sex or indices of renal function.
Adult↗
Case report: persistent colonic spasm concealing a carcinoma--an uncommon diagnostic pitfall of the barium enema examination.
Colonic carcinomas may be missed on the barium enema examination for a variety of perceptive, technical, and interpretive reasons. We report an uncommon source of error-persistent bowel spasm resulting in concealment of an underlying carcinoma. Awareness of this association is necessary in the effort to minimize diagnostic pitfalls of the barium enema examination.
Barium Sulfate↗
Acquired ability of Staphylococcus aureus to produce toxic shock-associated protein and resulting illness in a rabbit model.
Staphylococcus aureus from patients with toxic shock syndrome (TSS) produce TSS toxin 1. We transferred, by a bacteriophage, the ability to produce TSS toxin 1 from a TSS toxin 1-positive to a TSS toxin 1-negative strain of S. aureus. This recombinant strain produced TSS toxin 1 as confirmed by isoelectric focusing, immunodiffusion, radioimmunoassay, and autoradiography. The recombinant produced TSS-like illness in rabbits, and was significantly (P less than 0.001) more lethal than the recipient strain. Both strains produced fever and diarrhea, but, in addition, rabbits challenged with the recombinant also developed lowered blood pressure (P = 0.002), conjunctival hyperemia, erythroderma, and respiratory distress. Histopathological findings in rabbits challenged with the recombinant strain were remarkably similar to those described for humans with TSS, e.g., erythrophagocytosis, liver "triaditis," and vasodilatation. This study demonstrates that this protein may contribute to the pathogenesis of the TSS.
Animals↗
Toxic shock syndrome: modification and comparison of methods for detecting marker proteins in Staphylococcus aureus.
Development of a new medium and modification of incubation conditions increased production of toxic shock syndrome marker proteins and enabled detection of small volumes of pyrogenic exotoxin C (PEC) by isoelectric focusing and staphylococcal enterotoxin F (SEF) by a newly developed solid-phase radioimmunoassay. The results were compared with those obtained with previously described methods. The results were identical, and all PEC-positive isolates were SEF positive. In a second study of 262 randomly selected Staphylococcus aureus isolates examined by isoelectric focusing and solid-phase radioimmunoassay but grown in fresh beef heart medium, 47 (17.9%) isolates were PEC and SEF positive; however, 9 (3.4%) were PEC positive and SEF negative, and 3 (1.1%) were SEF positive and PEC negative. When grown in buffered beef heart yeast extract medium, six of the previously PEC-positive and SEF-negative isolates were PEC negative. Autoradiographic analysis of selected isolates demonstrated that PEC- and SEF-positive strains bound SEF antitoxin to the protein at isoelectric point 7.2, suggesting that in staphylococci from patients with toxic shock syndrome, PEC and SEF are the same protein. In screening staphylococci for toxic shock syndrome marker proteins, isoelectric focusing to identify PEC may detect false-positive proteins and may be more susceptible to technical variation than immunological methods to detect SEF.
Bacterial Proteins↗
In-vitro studies of interactions between tampons and Staphylococcus aureus.
In-vitro studies were done to investigate the role of tampons and Staphylococcus aureus in toxic shock syndrome. Tampons did not enhance the growth of S. aureus in nutrient broth or human blood. Intrinsic contamination of tampons with S. aureus was not found among the 504 tampons cultured (95% confidence limits of fraction contaminated; 0 to 0.007). Toxin-producing S. aureus persisted significantly longer on artificially contaminated Rely tampons (Procter & Gamble) than on the other brands tested. The proportion of clinical isolates of S. aureus capable of producing toxin increased from two of 36 in 1960 to eight of 20 in 1979 (p = 0.002, Fisher's exact test). This general increase in the proportion of toxin-producing strains may partially explain the increase in cases of toxic shock syndrome in recent years.
Bacillus↗
Pittsburgh pneumonia agent: direct isolation from human lung tissue.
Pittsburgh pneumonia agent (PPA) was recently cultivated from infected egg yold on charcoal yeast extract agar. PPA has now been isolated both from infected egg yolk and human lung tissue on charcoal yeast extract agar and on a new medium, buffered charcoal yeast extract agar. PPA resembles Legionella pneumophila and other Legionella-like organisms in requirements for growth and composition of fatty acids. It differs in genetic relatedness, antigenic composition, and colonial morphology and has distinctive characteristics that allow it to be identified. The name Legionella pittsburgensis species nova is proposed for this organism.
Animals↗
Risk assessment of pulmonary embolism by multivariate analysis.
A prospective study of 6,527 hospitalized patients was performed to evaluate the effectiveness of multivariate analysis of risk factors to correctly designate risk for pulmonary embolism. History of previous pulmonary embolism was the single most important factor. In patients without prior history, five factors emerged: inactivity, congestive heart failure, Doppler ultrasound evidence of deep-vein occlusion, female sex, and black race. Used together, these factors permitted a discrimination of risk such that 68.7% of pulmonary embolization was found to occur in 32.2% of the population designated as showing increased risk. Multivariate analysis of clinical factors improved assessment of risk, compared to the use of lower extremity findings alone, and proved to be useful in identifying individuals at increased risk for pulmonary embolism.
Analysis of Variance↗