An unusual renal mass after partial nephrectomy for renal cell carcinoma.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
U Patel
Publications and source records attributed to U Patel.
Multilaminate resorbable biomedical device under biaxial loading.
The design and test of a multilaminate sheet developed for a hernia repair application is presented. As biomaterial applications become more complex, characterization of uniaxial properties becomes insufficient and biaxial testing becomes necessary. A measure of the in-plane biaxial strength of the device is inferred from a ball burst test. The results of this test for different thicknesses of the device are correlated with the uniaxial strength of the material. A biaxial test such as the ball burst test is more indicative of the properties of a planar material than would be a uniaxial test. The interactions in the biaxial mode of failure are of value and can be related back to a classical uniaxial tensile test from the ball burst test. The material used in this study to fabricate the device was a resorbable biomaterial called small intestinal submucosa (SIS). The effects of rehydration on the stiffness and associated ball burst properties of the SIS device were also measured. It is shown that at a rehydration time of 5 min from a reference dry state, steady-state mechanical properties are reached.
Biocompatible Materials↗
Amplatz gooseneck snare in stripping of failing haemodialysis catheters.
Explore the source record for details and available documents.
Catheters, Indwelling↗
Perirolandic cortex in infants: signal intensity on MR images as a landmark of the sensorimotor cortex.
PURPOSE: To correlate the perirolandic low signal intensity seen on T2-weighted magnetic resonance (MR) images in neonates and infants with the anatomically located sensorimotor cortex. MATERIALS AND METHODS: Axial T2-weighted MR images of 146 consecutive patients less than 6 months old were reviewed. The sensorimotor cortex was located by identifying the central sulcus. Two independent readers attempted to identify the central sulcus using two anatomic methods independently and in combination. The location of the central sulcus was compared with that of the perirolandic low signal intensity. RESULTS: Seventy-two normal hemispheres in 36 patients and 91 abnormal hemispheres in 47 patients showed clear perirolandic low signal intensity. The central sulcus was located anatomically in 70 and 72 normal hemispheres (97% and 100%, respectively) and 90 and 91 abnormal hemispheres (99% and 100%, respectively). In all normal hemispheres, the identified central sulcus correlated with the perirolandic low signal intensity. In contrast, an apparent mismatch was found in two hemispheres in a patient with Dandy-Walker syndrome. CONCLUSION: The perirolandic low signal intensity seen on T2-weighted MR images is located exactly in the anatomic sensorimotor cortex in normal brains, whereas a mismatch can occur in abnormal brains.
Bacterial Infections↗
MR imaging of the mamillothalamic tract.
PURPOSE: To demonstrate the normal and abnormal appearance of the mamillothalamic tract (MTT) on cranial magnetic resonance (MR) images. MATERIALS AND METHODS: Two formalin-fixed normal human brain specimens sectioned in axial and coronal planes were used to demonstrate the normal anatomy of the MTT. MR images were obtained in 32 volunteers. Proton-density-weighted coronal and axial pulse sequences were used. The images were evaluated for visualization quality and size and signal intensity of the MTTs in correlation with the specimens. Abnormal MTTs were identified on cranial MR images in two patients, and the imaging findings were analyzed. The clinical history of the patients was also reviewed to determine the effect of these findings on patient care. RESULTS: Normal MTTs were easily identified on MR studies of cadaveric brains and of the brains of the human volunteers. On MR images, normal MTTs were commonly symmetric in appearance, with signal intensity equal to that of other normal fiber tracts. The abnormal MTTs showed high signal intensity on images obtained with a long repetition time or asymmetric volume loss and were associated with atrophy of the ipsilateral mamillary body. CONCLUSION: Normal MTTs are readily visible on conventional MR images. Abnormality of the MTT is a very subtle finding but may be a marker of a limbic system abnormality.
Adult↗
Developmental and hormonal regulation of transforming growth factor-beta1 (TGFbeta1), -2, and -3 gene expression in isolated prostatic epithelial and stromal cells: epidermal growth factor and TGFbeta interactions.
Growth factors are postulated to mediate stromal-epithelial interactions in the prostate to maintain normal tissue physiology. Transforming growth factor-beta (TGFbeta) has been shown to influence the prostate and probably mediate stromal-epithelial interactions. TGFbeta1 messenger RNA (mRNA) expression is stimulated after castration and can be suppressed by in vivo treatment with androgens. The hypothesis tested is that TGFbeta is regulated not only by androgen, but also by a network of locally produced growth factors that influence prostatic growth and differentiation. Epithelial and stromal cells from 20-day-old rat ventral prostate were isolated and used to test this hypothesis. The expression of mRNA for TGFbeta1, -2, and -3 was analyzed by a quantitative RT-PCR procedure. Observations from this assay demonstrate that both epithelial and stromal cells express the mRNA for TGFbeta1, -2, and -3. TGFbeta1 mRNA expression was constant during development of the prostate. TGFbeta2 mRNA expression was elevated at birth, then declined and elevated again at 100 days of age. TGFbeta3 mRNA expression was high during puberty and young adult ages then declined at 100 days of age. TGFbeta2 and TGFbeta3 expression are inversely related during prostate development. After castration of 60-day-old rats, both TGFbeta1 and TGFbeta2 mRNA were enhanced. Interestingly, TGFbeta3 mRNA was significantly suppressed after castration. Epidermal growth factor (EGF) stimulated TGFbeta1 mRNA expression in stromal cells (6-fold increase), whereas keratinocyte growth factor stimulated TGFbeta2 mRNA in epithelial cells. TGFbeta inhibited both testosterone- and EGF-stimulated prostatic stromal and epithelial cell growth. EGF and TGFbeta also inhibited prostatic ductal morphogenesis and growth in organ culture. Immunocytochemical localization of TGFbeta in 20-day-old prostate demonstrated predominately stromal localization of the protein. These results indicate that the isoforms of TGFbeta2 and TGFbeta3 are differentially regulated during prostate development, suggesting distinct regulatory mechanisms. Testosterone did not affect TGFbeta expression in cultured prostatic cells. These observations suggest that the in vivo effects of castration on TGFbetas are regulated indirectly through a complex network of growth factors, not simply by direct androgen depletion. The ability of EGF to inhibit prostatic ductal morphogenesis and growth in organ culture is postulated to be in part mediated by the increase in TGFbeta1 expression. In summary, a network of growth factor-mediated stromal-epithelial interactions is needed to maintain prostate growth and development. TGFbeta is postulated to have an important role in this process.
Animals↗
Developmental and hormonal regulation of transforming growth factor-alpha and epidermal growth factor receptor gene expression in isolated prostatic epithelial and stromal cells.
Androgen has an important role in development of the prostate, and the actions of androgen are mediated, in part, by locally produced growth factors. These growth factors are postulated to mediate stromal-epithelial interaction in the prostate to maintain normal tissue physiology. Transforming growth factor-alpha (TGF-alpha) is one of the growth factors that can stimulate prostatic growth. The expression of TGF-alpha is thought to be regulated by androgen. The expression of epidermal growth factor receptor (EGFR), which is the receptor of TGF-alpha and EGF, also may be regulated by androgen. The hormonal and developmental regulation of TGF-alpha and EGFR messenger RNA (mRNA) levels in isolated epithelial and stromal cells from rat ventral prostate was investigated. The expression of mRNA for TGF-alpha and EGFR was analyzed by a quantitative RT-PCR (QRT-PCR) procedure developed. Observations from this assay demonstrated that both epithelial and stromal cells expressed the mRNA for TGF-alpha and EGFR. TGF-alpha mRNA expression was constant during postnatal, pubertal, and adult development of the prostate. EGFR mRNA expression was elevated at the midpubertal period and decreased with age. After castration of 60-day-old adult rats, both TGF-alpha and EGFR mRNA were significantly enhanced. TGF-alpha mRNA expression was stimulated by EGF in stromal cells (4.5-fold increase) but was not changed by any treatment in epithelial cells. EGFR mRNA levels were stimulated by EGF and keratinocyte growth factor treatment and inhibited by testosterone treatment in epithelial cells. Stromal cell EGFR mRNA levels were not affected by any treatment. Both testosterone and EGF stimulated incorporation of 3H-thymidine into prostatic stromal and epithelial cells. Anti-TGF-alpha antibody significantly inhibited testosterone-stimulated 3H-thymidine incorporation into stromal cells and epithelial cells. Immunocytochemical localization of TGF-alpha and EGFR demonstrated expression on the luminal surface of epithelial cells within prostatic ducts, and minimal expression was observed in stromal cells. Results indicate that testosterone does not directly regulate TGF-alpha mRNA levels but does inhibit EGFR mRNA levels. Interestingly, anti TGF-alpha antibody suppressed the effect of testosterone on 3H-thymidine incorporation into prostatic stromal and epithelial cells. This finding suggests that testosterone may act indirectly on prostatic cells to influence TGF-alpha actions. TGF-alpha mRNA levels were influenced by EGF in stromal cells only, and EGFR mRNA levels were influenced by testosterone, EGF, and keratinocyte growth factor in epithelial cells. These observations suggest that regulation of TGF-alpha and EGFR is distinct between the cell types. In conclusion, a network of hormonally controlled growth factor-mediated stromal-epithelial interactions is needed to maintain prostate development and function.
Animals↗
MR imaging of CNS tractopathy: wallerian and transneuronal degeneration.
Explore the source record for details and available documents.
Adult↗
Pseudoaneurysm of the petrous internal carotid artery after skull base infection and prevertebral abscess drainage.
A 37-year-old woman with a skull base infection sustained massive oropharyngeal bleeding after incisional nasopharyngeal biopsy and drainage of a prevertebral abscess. A pseudoaneurysm originating at the petrous portion of the internal carotid artery was initially misinterpreted on MR images as typical postoperative change within a resolving abscess cavity. Follow-up MR imaging and conventional angiography ultimately disclosed the pseudoaneurysm.
Abscess↗
MR of spinal cord ganglioglioma.
PURPOSE: Our purpose was to describe the MR imaging features in a series of spinal intramedullary gangliogliomas and to compare these findings with the MR features of intramedullary astrocytomas and ependymomas. METHODS: A retrospective analysis was performed of 76 MR examinations in 27 patients with histologically proved spinal ganglioglioma; these were then compared with imaging findings in a representative sample of histologically proved spinal cord astrocytomas and ependymomas. RESULTS: Statistically significant observations regarding spinal gangliogliomas included young age of the patients (mean, 12 years), long tumor length, presence of tumoral cyst, presence of bone erosion and scoliosis, absence of edema, presence of mixed signal intensity on T1-weighted images, and presence of patchy enhancement and cord surface enhancement. A trend (not statistically significant) was noted for holocord involvement and lack of magnetic susceptibility. CONCLUSION: Spinal ganglioglioma can be strongly suspected if MR images reflect the above criteria; however, the ultimate diagnosis still depends on radical resection and appropriate histopathologic investigation.
Adult↗
Castleman's disease as a rare cause of a neck mass in a child.
Explore the source record for details and available documents.
Biopsy↗
Phenotypic variability of CADASIL and novel morphologic findings.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a non-arterio-atherosclerotic, non-amyloidotic arteriopathy affecting preferentially the small arteries and arterioles of the brain. The morphologic hallmark is the presence of a characteristic granular alteration of the arterial media that ultrastructurally corresponds to the accumulation of electron-dense material surrounding the smooth muscle cells. Although the presence of this granular osmiophilic material (GOM) was originally described as limited to brain vessels, identical electron microscopic findings have been demonstrated in the media of peripheral tissue arteries, allowing for a pathologic diagnosis of the disease by a simple skin, muscle or nerve biopsy. We report some atypical features identified in our CADASIL patients that broaden the phenotypic expression of this disease. Firstly, we identified a cortical infarct in an otherwise typical CADASIL patient. Secondly, we observed GOM in skin arteries of a 30-year-old man with hemiplegic migraine, the son of a woman who had died with CADASIL. This confirms that it may be possible to diagnose the disease at a preclinical stage by the ultrastructural evaluation of peripheral tissue biopsy material, particularly for individuals for whom there is a supporting family history. Thirdly, ultrastructural examination of the skin, and subcutaneous and striated muscle of an unrelated and apparently sporadic patient with neuropathologic and neuroradiologic evidence of CADASIL in meningeal and cerebral vessels failed to reveal diagnostic lesions in peripheral arteries. Thus, the possibility of a false-negative pathologic diagnosis in patients with a clinicoradiologic diagnosis of CADASIL, if one relies solely on a peripheral tissue biopsy, does exist. Additionally, we have identified heat shock proteins (Hsp70 and alphaB crystallin) and ubiquitin in the vascular myocytes of affected arteries. B crystallin also seemed to be deposited extracellularly, which suggests that GOM also might be immunoreactive for alphaB crystallin.
Adult↗
Solitary subglottic neurofibroma: MR findings.
We present a case of subglottic neurofibroma, which is of interest because laryngeal neurofibroma rarely occurs in the subglottic space. Nonspecific MR findings did not allow us to exclude the preoperative diagnosis of hemangioma.
Biopsy↗
Ureteric obstruction secondary to endometriosis. Ultrasonography is best method of detection.
Explore the source record for details and available documents.
Endometriosis↗
Ureteric drainage and peristalsis after stenting studied using colour Doppler ultrasound.
OBJECTIVE: To study peristalsis and drainage of the stented ureter under normal physiological conditions. PATIENTS AND METHODS: Fifteen non-obstructed patients with ureteric stents and 15 control subjects (i.e. 45 unstented ureters and 15 stented ureters) had ureteric jets and flow analysed using colour Doppler ultrasound (CDU). Cross-sectional and longitudinal studies were performed. RESULTS: Unstented ureters had forceful ureteric jets at a frequency of 0.5-4 jets/min per ureter. Asymmetry of frequency within subjects was common (1-3 jets/min). Some patent stented ureters had no recordable flow on CDU (four cases, three within the first week of stenting). In the remainder, three types of flow pattern were recorded; weak peristaltic jets were seen in a minority (four of 15), flow around the stent (periprosthetic flow) in 11 of 15 and flow through the lumen (luminal flow) in eight of 15. Jets were only seen late after stenting (> 2 months). The periprosthetic flow was mildly peristaltic in some patients and periprosthetic and jet flow increased relative to luminal flow during peak diuresis. CONCLUSIONS: Passive drainage (periprosthetic and luminal flow) is the principal mode of urine transport in the stented ureter throughout the diuretic response and particularly within a week of stenting. With longer duration of stenting (> 2 months) weak peristaltic activity and active ureteric transport became more evident, notably during peak diuresis. CDU is not reliable for diagnosing obstruction of the stented ureter.
Adult↗
Myocardial mechanics and energetics during continuous positive airway pressure in sedated pigs.
OBJECTIVE: To test the hypothesis that increased cardiac output with continuous positive airway pressure (CPAP) leads to increased myocardial metabolic cost. DESIGN: Prospective, repeated-measures, laboratory studies. SETTING: University-affiliated hospital animal research laboratory. SUBJECTS: Eight sedated pigs that had been previously instrumented for collection of hemodynamic data. INTERVENTIONS: Application of CPAP at 0, 5, 10, and 15 cm H2O and recovery under conditions of normal blood volume (normovolemia) and after administration of hetastarch 35 mL/kg (hypervolemia). MEASUREMENTS AND MAIN RESULTS: We measured mean arterial pressure, cardiac output, systemic vascular resistance index, the first derivative of the left ventricular pressure at a left ventricular pressure of 50 mm Hg, rate-pressure product, left ventricular tension-time index, stroke work index, myocardial pressure-myocardial segment length area, coronary artery blood flow and coronary vascular resistance, and myocardial oxygen consumption (four pigs). With normovolemia, cardiac output decreased with CPAP (4.9 +/- 1.2 L/min at CPAP of 0 cm H2O to 4.5 +/- 1.3 L/min at CPAP of 15 cm H2O, p < .005) and systemic vascular resistance index increased (2509 +/- 702 to 3095 +/- 1080 dyne.sec/cm5.m2, p < .01). With hypervolemia, cardiac output increased at low-level CPAP (5.7 +/- 1.4 L/min at CPAP of 0 cm H2O to 6.4 +/- 1.6 L/min at CPAP of 5 cm H2O, p < .05) and systemic vascular resistance index decreased (2412 +/- 552 to 2033 +/- 436 dyne.sec/cm5.m2, p < .01). There were no associated significant changes in myocardial oxygen consumption, or its major correlates when cardiac output increased with CPAP (hypervolemic conditions). CONCLUSIONS: In normal pigs, there is no change in myocardial oxygen demand with CPAP, whatever the change in cardiac output. Thus, increased cardiac output with CPAP carries little extra metabolic cost. Increased cardiac output with low-level CPAP in hypervolemia is associated with systemic vasodilation.
Alfaxalone Alfadolone Mixture↗
New antihistamines: substituted piperazine and piperidine derivatives as novel H1-antagonists.
Structural manipulation of polycyclic piperazinyl imide serotonergic agents led to the synthesis of compound 8, 2-[4-[4-[bis(4-fluorophenyl)methyl]-1-piperazinyl]-4, 4a,5,5a,6,6a-hexahydro-4,6-ethenocycloprop[f]isoindole-1,3(2H,3 aH)-dione, which demonstrated good H1-antagonist activity. Substitution of a xanthinyl moiety for the polycyclic imide group led to the identification of novel xanthinyl-substituted piperazinyl and piperidinyl derivatives with potent antihistamine H1-activity without the undesirable antidopaminergic activity of 8. One compound, 24, 7-[3-[4-(diphenylmethoxy)-1-piperidinyl]propyl]- 3,7-dihydro-1,3-dimethyl-1H-pyrine-2,6-dione (WY-49051), is a potent, orally active H1-antagonist with a long duration of action and a favorable central nervous system profile.
Animals↗
Domiciliary radiography: an important service?
General practitioners' (GP) perceptions, comparative costs and potential influence on patient management of a domiciliary radiography service were reviewed. A postal questionnaire was sent to 159 local GPs, 130 of whom responded. Seventy-one per cent of respondents had requested domiciliary radiography in the previous year and 79% felt loss of the service could potentially be detrimental. Although 98% recognized that a chest X-ray was a suitable domiciliary radiography examination, 6% thought that a barium swallow could be adequately carried out with domiciliary equipment. Forty-nine per cent perceived a need for a domiciliary ultrasound service. Sixty-three per cent believed that domiciliary radiography was cheaper than return ambulance transport with departmental examination, although estimates showed a domiciliary visit to cost 82 pounds versus 60 pounds for a departmental visit. A retrospective review of 50 consecutive domiciliary radiography examinations showed that elderly and immobile patients were imaged most frequently. Malignancy was diagnosed in 14%, infection in 26% and a fracture in 14%. Overall there was an anticipated management change in 50% of patients.
Adult↗