Biomedical subjects
Publications and source records attributed to R Kidd.
Single crystals of L-aspartate ammonia-lyase (L-aspartase) from Escherichia coli have been obtained by microdialysis at room temperature using polyethylene glycol 3350 and sodium acetate as co-precipitants. The crystals exhibit the symmetry of space group P2(1)2(1)2 with a = 156.5 A, b = 147.6 A, c = 102.5 A and diffract at least to 2.8 A.
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A simple, commercially available 6.5-3.0 French coaxial catheter system was used to obtain the subselective catheter position for diagnostic or interventional (drug infusions, embolizations) angiography. The system was employed 81 times in 75 patients without complication. We describe the catheter system, techniques for its use, and its clinical applications.
The functional capability of antigen-stimulated breast milk cells to produce an immunologic mediator was examined. Colostrum and comparison peripheral blood samples were obtained from ten women, two to four days postpartum, and supernatants from PPD-stimulated mononuclear cell cultures were assayed for the lymphokine, monocyte chemotactic factor. Five of the ten women studied had a history of a positive tuberculin skin test and one had received BCG immunization. Peripheral blood lymphocyte cultures and colostrum cell cultures from four of these six women produced monocyte chemotactic factor. These results demonstrated the functional capability of antigen-stimulated colostral cells to produce immunologic mediators.
Clinical acceptance of lymphangiography has been limited primarily by a high false-negative rate. Two recent reports suggest that fine-needle aspiration biopsy of lymphangiographically normal lymph nodes can detect "silent" metastases, thereby improving lymphangiography as a staging procedure. Aspiration biopsies were performed on radiographically normal lymph nodes bilaterally in 49 patients with carcinoma of the prostate or bladder, without detecting a single metastasis. Even though fewer nodes were biopsied in each case than in the two previous studies, the results of this study cast doubts on the assertion that percutaneous aspiration biopsy of lymphangiographically normal nodes can detect most nodal metastases.
Four hundred thirty-six patients with carcinoma of the prostate had lymphangiography (LAG) as part of their initial evaluation before treatment. Fine-needle aspiration biopsy (FNAB) of abnormal opacified lymph nodes was performed routinely. The positivity rate of LAG and FNAB in each clinical stage was compared with the positivity rate predicted for that stage, based on published series of patients with carcinoma of the prostate who underwent pelvic lymph node dissection (LND). Within each clinical stage, the relation of the outcome of LAG/FNAB to histologic tumor grade (Gleason score) and serum acid phosphatase levels was evaluated. LAG/FNAB was of very limited value in patients with less than clinical stage C disease and of no value in patients with a Gleason score of less than 6. Although LAG/FNAB is insensitive even in clinical stage C disease, a positive result will avoid the morbidity and expense of a staging LND and allow confident selection of appropriate treatment. A negative LAG/FNAB, on the other hand, is meaningless, because of the high false-negative rate of LAG. Since no two study populations are exactly alike, any evaluation or comparison of tests used to stage patients with carcinoma of the prostate should state the distribution of its patients by clinical stage.
Extrinsic processes affecting the bowel are frequently mistaken for intrinsic gastrointestinal disease. However, extrinsic involvement of bowel produces morphologic changes distinguishable from those of primary diseases of bowel in most cases. These changes include (a) an intact mucosal surface, (b) mass effect, (c) fixation and angulation mucosal folds, (d) fixation and angulation of bowel loops, and (e) luminal constriction. The extrinsic process involving bowel most often encountered on barium studies is metastatic neoplasm; other causes are inflammatory disease, adhesions, and endometriosis. Although the radiographic manifestations of extrinsic processes affecting bowel are nonspecific, when correlated with clinical information they may permit an astute diagnosis.
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In patients with a radiologic diagnosis of unresectable pancreatic carcinoma, exploratory laparotomy for tissue diagnosis is no longer required. Histologic confirmation of the diagnosis may be obtained safely and accurately with percutaneous fine-needle aspiration biopsy. Endoscopic retrograde cholangiopancreatography (ERCP) precisely localized the biopsy site for cytologic diagnosis of adenocarcinoma in 13 of 14 patients (93 percent) with pancreatic carcinoma.
Five patients with Child's class C alcoholic cirrhosis and actively bleeding gastroesophageal varices underwent transhepatic portal venography and selective obliteration of varices with isobutyl 2-cyanoacrylate (Bucrylate). Temporary control of bleeding was obtained in four patients and complete control in one. This new technique is best utilized to stop active variceal hemorrhage in patients who are not candidates for portasystemic shunt surgery or to control bleeding while the patient's general medical condition is improved to decrease the risk of subsequent shunt surgery.
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Transcatheter occlusive therapy was performed with isobutyl 2-cyanoacrylate (Bucrylate) in 14 patients with a variety of genitourinary abnormalities. Bucrylate was found to be a valuable agent when used to: (1) occlude vessels with very slow flow; (2) occlude vessels in patients with coagulopathies; (3) occlude high flow arteriovenous fistulas; (4) perform superselective vessel occlusion; and (5) produce permanent vessel obliteration. Bucrylate was used effectively in this group of patients and was used without complications or evidence of histotoxicity.