Does industrial handling of polypropylene cause colorectal cancer?
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Adult↗
Biomedical subjects
S Kay
Publications and source records attributed to S Kay.
A patient care workstation based on user centred design and a formal theory of medical terminology: PEN&PAD and the SMK formalism.
The PEN & PAD clinical workstation is for use by clinicians for direct patient care. It is based on a highly structured and detailed medical record but is intended to be simple and intuitive to use, allowing clinicians to summarise and view information in many ways, and quickly enter information through structured forms. It also provides mechanisms for tailoring the system to individual users without compromising its overall integrity. This has been achieved by following a process of user centred design and by developing a novel formalism, Structured Meta Knowledge, to represent the terminological knowledge, the medical record, and pragmatic knowledge about clinical practice.
Ambulatory Care Information Systems↗
Foundations for an electronic medical record.
Given the many efforts currently under way to develop standards for electronic medical records, it is important to step back and reexamine the fundamental principles which should underlie a model of the electronic medical record. This paper presents an analysis based on the experience in developing the PEN & PAD prototype clinical workstation. The fundamental contention is that the requirements for a medical record must be grounded in its use for patient care. The basic requirement is that it be a faithful record of what clinicians have heard, seen, thought, and done. The other requirements for a medical record, e.g., that it be attributable and permanent, follow naturally from this view. We use the criteria developed to re-examine Weed's Problem Oriented Medical Record and also relate the criteria to secondary uses of the medical record for population data, communications and decision support.
Decision Making↗
Multimodal treatment of adult intracranial gliomas.
Recent advances, experimental treatments and future protocols of adult intracranial gliomas are discussed in this article. Adult intracranial gliomas are not benign, and most are incurable with poor prognosis, despite aggressive treatment. Breakthroughs will be found only through well-designed, experimental protocol evaluation on patients with intracranial gliomas.
Adult↗
Now I'm somebody special.
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Amputation, Traumatic↗
A 268 bp upstream sequence mediates the circadian clock-regulated transcription of the wheat Cab-1 gene in transgenic plants.
We previously reported that the expression of the wheat Cab-1 gene is regulated by an endogenous circadian rhythm and by the photoreceptor phytochrome both in wheat and in transgenic tobacco plants. To define regulatory elements necessary for the circadian rhythm-regulated Cab-1 gene expression, we now analysed the fluctuation of steady-state mRNA levels in a series of 5' deletion mutants in transgenic tobacco plants. We found that the expression of a deletion mutant containing 211 bp upstream sequence still exhibited circadian rhythm. Furthermore we show that an enhancer-like sequence of the Cab-1 promoter (from -357 to -90) can endow a chimaeric gene consisting of a truncated 35S promoter (from -90 to +8) and the bacterial beta-glucuronidase (GUS) gene with circadian clock-regulated gene expression. Finally we demonstrate by nuclear run-off experiments that the transcription rates of the Cab genes in wheat oscillate in a rhythmic manner, with a periodicity of approximately 24 hours. Consistent with our previous findings these results (i) indicate that the expression of the wheat Cab-1 gene is regulated mainly at the transcription level and (ii) identify a short promoter region between -211 and -90 that is responsible for the circadian clock-regulated gene expression.
Amino Acid Oxidoreductases↗
Computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis.
In this study, the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system. Fourteen percent of the patients were classified as Stage I (single-focus disease); 36% as Stage II (multifocal disease responsive to conservative therapy); 32% as Stage III (diffuse disease partially responsive to medication); and 16% as Stage IV (diffuse disease associated with bony changes and poorly responsive to conservative treatment). The incidence of recurrent or persistent disease ranged from 13% for Stage II to 30% for Stage IV. Stage I and III patients had 13% and 18% recurrence rates, respectively. Computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticator of the disease process.
Chronic Disease↗
Characterization of a simplified method of cryopreserving human parathyroid tissue.
Cryopreservation of human parathyroid tissue plays an important role in managing difficult parathyroid disease. It also can permit investigators to conduct experiments without dependence on the operating room schedule. Availability of cryopreservation has been limited by the perceived need for expensive, complex equipment. We adapted a simple method of freezing cell suspensions to freezing human parathyroid tissue. Vials containing human parathyroid in culture media, dimethylsulfoxide, and patient serum were placed in a plastic rack in a metal pan containing prechilled (4 degrees C) ethanol and placed in a -70 degrees C freezer. We compared viability (trypan blue dye exclusion by collagenase dispersed cells) of tissue frozen in this manner to that of tissue frozen in a programmable liquid nitrogen freezer at 1 degrees C per minute, a cooling rate recommended for human parathyroid tissue. The viability of 30 patients' samples cooled in liquid nitrogen (average length of storage 5 months) was 74% +/- 15% and that of 64 patients' samples cooled in ethanol (average length of storage 26 months) was 71% +/- 15%. Viability of 19 samples of fresh tissue was 79% +/- 10%. Neither method had a statistically significant correlation between length of storage and viability. Successful cryopreservation with simplified technology may expand the availability of parathyroid tissue to meet both clinical and investigative requirements.
Cell Survival↗
B cells in thymomas.
Although previous studies demonstrated thymoma-associated lymphocytes to be T cells, six thymomas were identified with germinal centers (GC) inside the tumor capsule. Three were mixed lymphocytic and epithelial thymomas. These tumors contained GC interspersed throughout and were not associated with myasthenia gravis (MG) or with GC in adjacent thymus. Three other tumors were lymphocytic thymomas with subcapsular GC. These thymomas occurred in MG patients and were associated with GC in adjacent non-neoplastic thymus. Immunoperoxidase studies using antibodies LN1, LN2, and L26 confirmed the presence of B cells in thymomas, particularly those with germinal centers. The presence of B cells in certain thymomas must be considered when studying the association of Epstein-Barr virus with thymic tumors. Germinal centers in a thymoma are not necessarily associated with myasthenia gravis.
Antibodies, Monoclonal↗
Nerve sheath myxoma of digital nerve.
A case of a dermal nerve sheath myxoma arising in a digital nerve is reported. Similar tumors and its variants have been termed neurothekeoma, pacinian neurofibroma, bizarre cutaneous neurofibroma, and plexiform neurofibroma. The perineural sheath or the Schwann cell have been presumed to be the cell of origin by several investigators. The positive reaction with antibody to S-100 would appear to favor the Schwann cell as the progenitor of this tumor.
Adult↗
Natural history and treatment of mucosal melanoma.
Forty-three patients with primary mucosal melanomas seen between 1960 and 1987 were reviewed. There were 17 patients with tumors arising from the head and neck, 17 from the vulva and/or vagina, 8 from the anorectum, and 1 from the esophagus. Twenty-one patients were resected with curative intent. In patients with head and neck tumors, local recurrence was the initial cause of failure in the majority of cases, whereas with tumors arising from the anorectum, vulva, and vagina, systemic recurrence was more common. There were four long-term survivors, and three of these had melanomas less than 1 mm thick with negative regional lymph nodes; no patients with mucosal melanoma less than 1 mm thick developed recurrent disease. Overall, actuarial survival was 64% after 1 year and 23% after 5 years. Mucosal melanoma has a poor prognosis, and adequate resectional surgery affords the only chance of long-term survival.
Actuarial Analysis↗
Ring avulsion injuries: classification and prognosis.
Fifty-five cases of ring avulsion injury were reviewed to examine how extent of injury and surgical management correlated with results. After injury, three patients had adequate circulation. Of 52 patients with inadequate circulation, 8 had primary amputation; salvage was attempted in 44. Of these 44, 9 fingers were amputated secondarily, 19 were successfully revascularized, and 16 were successfully replanted. Return-to-work time averaged between 4.5 and 10.3 weeks. Cold symptoms occurred in 65% of salvaged fingers. Range of motion was usually normal at the metacarpophalangeal joint; most patients had 90 degrees or better combined arc of motion at the proximal and distal interphalangeal joints. Two-point discrimination of less than 10 mm returned in 47% of patients with injured nerves. Most patients whose fingers were successfully salvaged were glad they had had the procedure. We conclude that amputated digits are salvageable and propose a classification system that includes skeletal injury.
Adolescent↗
Segmental medullary sponge kidney mimicking a renal mass.
We report an unusual case of a medullary sponge kidney that presented clinically and radiologically as a renal mass. Histopathological study after nephrectomy proved the mass to be consistent with segmental medullary sponge kidney.
Diagnosis, Differential↗
Management of desmoid tumors.
Desmoid tumors are rare, being less than 0.03 per cent of all neoplasms. Because of scarcity of data and relatively small numbers of patients, optimal treatment remains controversial. In this report, our experience with 36 patients evaluated and treated from 1960 to 1987 is analyzed. The most common primary site was the wall of the chest (ten); eight tumors originated in the abdominal wall. Nine patients had a history of previous trauma, and eight of these were women. Thirty-two patients had wide local excision and two had amputations. Clear margins were obtained in only 22 patients despite an attempt at wide resection in all instances. With a mean follow-up period of 41 months and a median of 24 months, only one of 22 patients with negative histologic margins had recurrence of tumor. Among the 11 patients with positive margins, four received postoperative radiation therapy and two remain disease-free; of the seven remaining patients with positive margins, three had recurrences. One patient with unresectable disease was treated with tamoxifen with regression of tumor and remains alive 15 months later. These data suggest that the best treatment of desmoid tumors remains resection with a clear margin of normal tissue surrounding the tumor. Adjuvant radiotherapy did not appear to decrease the rate of local recurrence.
Actuarial Analysis↗
Late presentation of ulcerative colitis in ex-smokers.
Details of the smoking history were obtained from 288 patients with ulcerative colitis who were more than 15 years of age when colitis developed. Men who had previously smoked presented with colitis at a later age than lifelong non-smokers (mean age difference 15.2 years). The proportion of ex-smokers in this group of patients with colitis was more than twice that expected in the general population. The interval between cessation of smoking and subsequent onset of colitis in ex-smokers was found to be relatively short and in two-thirds of patients occurred within seven years. A tentative model to explain the association between smoking and subsequent colitis is proposed. We suggest that whilst current smokers may have a lower incidence of colitis, ex-smokers appear to be at increased risk of developing the disease. An alternative explanation is that smoking may act in a manner analogous to sulphasalazine.
Adult↗
Principles in the management of pediatric intestinal leiomyosarcomas.
Primary intestinal leiomyosarcomas in children are unusual tumors with little known about their natural history. Two patients (aged 9 and 10 years) with leiomyosarcoma of the jejunum treated at our institution are reported and added to the 20 other patients reported in the literature. The first patient had a grade 1 leiomyosarcoma completely resected, received no additional therapy, and remains alive with no evidence of disease 14 years later. The second patient presented with a perforated grade 2 leiomyosarcoma which was incompletely resected; he received combination chemotherapy with an initial good response, but eventually died from sarcomatosis 7 years after initial diagnosis. The 22 cases of pediatric intestinal leiomyosarcoma presented more commonly with obstruction or perforation, were able to be completely resected more often, and appear to have a better prognosis than in adults. Thus, intestinal leiomyosarcomas in children appear to have a natural history different from that of the same tumor arising in adults.
Child↗
Endometrial carcinoma arising in a large polypoid adenomyoma of the uterus.
A case of endometrial carcinoma arising in a large adenomyomatous polyp is described in a 75-year-old woman. The malignant element appeared to be a mixed adenosquamous carcinoma that was embedded in diffuse adenomyomatous infiltration. The lesion was entirely intramural, and the surface endometrium was atrophic and not neoplastic. The absence of endometrial involvement led to a 6-year delay before hysterectomy was carried out. Pathologic study of the radically excised uterus showed evidence of metastasis to one paraaortic lymph node. Since this appears to be the first example of such an event, the English literature was reviewed for the associated findings of adenomyosis and carcinoma in an intramural setting with noninvolvement of the surface endometrium.
Adenocarcinoma↗
Gastrointestinal sarcomas. Analysis of prognostic factors.
Clinical and pathologic data from 51 patients with primary sarcomas of the gastrointestinal tract treated from 1951 through 1984 were reviewed to determine clinical presentation, histologic features, treatment, and prognostic factors. The most common signs and symptoms were abdominal pain (62%), gastrointestinal bleeding (40%), and/or abdominal mass (38%). The primary site was stomach in 50%, small bowel in 30%, colorectum in 15%, and esophagus in 5%. Virtually all the sarcomas were leiomyosarcomas. Distribution was uniform among the three histologic grades; although 88% of Grade 1 tumors could be completely excised, only 35% of Grade 3 tumors could be completely resected. The 5-year survival rate was 75% for Grade 1 tumors, 16% for Grade 2 tumors, and 28% for Grade 3 tumors (p = 0.0013, Grade 1 vs. 2 and 3). Thirty of the 51 patients (59%) had curative resection with an operative morbidity rate of 24% and an operative mortality rate of 12%; at 5 years the disease-free survival rate was 58% and the overall survival rate was 63% (48% at 10 years). Eleven patients (42%) had recurrent disease develop at a median interval of 2 years after complete tumor excision. Twenty-one patients (41%) had partial excision or biopsy only of their tumors with an operative morbidity rate of 28%, operative mortality rate of 8%, and median survival of only 9 months. Overall, patients whose tumors were confined to the site of origin had a 58% 5-year survival rate compared with 20% for those whose tumors had invaded adjacent organs (p less than 0.05). If the tumor was less than 10 cm in size, the 5-year survival rate was 78%, significantly better than the 38% for tumors greater than 10 cm (p = 0.03). These data suggest that histologic grade, local invasiveness, size, and extent of resection are the most important prognostic factors for patients with primary gastrointestinal sarcomas. Patients who have resection of all gross tumor, especially if it is well differentiated and localized, have a good prognosis.
Adolescent↗