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At least 109 records · Page 6Linked to original sources

PubMed1995

Brain herniation: a revision of classical concepts.

This paper is an update on evolving ideas about brain herniations. Following observations on cerebellar pressure coning that raised doubts about its reputed lethal connotations, herniation at the tentorium was re-examined for its role in critically damaging the brain stem. Combining clinical, pathologic, computed tomography and magnetic resonance imaging data, it is concluded that temporal lobe herniation is not the means by which the midbrain sustains irreversible damage in acute cases, but rather lateral displacement of the brain at the tentorium is the prime mover and herniation a harmless accompaniment. Transtentorial herniation has been investigated with computed tomography using the three calcification relationship and descent through the tentorial opening could not be documented. Bilateral brain stem compression in acute bilateral cases must be distinguished from herniation. Upward cerebellar herniation is only the sign of an overfull posterior fossa. Subfalcial herniation is tolerated unless lateral displacement is excessive.

Brain↗

PubMed2005

From signatures to models: understanding cancer using microarrays.

Genomics has the potential to revolutionize the diagnosis and management of cancer by offering an unprecedented comprehensive view of the molecular underpinnings of pathology. Computational analysis is essential to transform the masses of generated data into a mechanistic understanding of disease. Here we review current research aimed at uncovering the modular organization and function of transcriptional networks and responses in cancer. We first describe how methods that analyze biological processes in terms of higher-level modules can identify robust signatures of disease mechanisms. We then discuss methods that aim to identify the regulatory mechanisms underlying these modules and processes. Finally, we show how comparative analysis, combining human data with model organisms, can lead to more robust findings. We conclude by discussing the challenges of generalizing these methods from cells to tissues and the opportunities they offer to improve cancer diagnosis and management.

Algorithms↗

PubMed2002

Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care.

OBJECTIVE: To evaluate today's refined neurosurgical intensive care of patients with traumatic brain injury after implementation of an organized secondary insult program focused on the importance of avoiding secondary brain damage together with a standardized treatment protocol system. DESIGN: Clinical observational patient study. PATIENTS: A total of 154 patients 16-79 yrs of age with acute head trauma and pathologic computed tomographic findings treated between 1996 and 1997. SETTING: Neurointensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Good recovery was obtained in 44% of the patients, moderate disability in 35%, severe disability in 16%, and no patient remained in a vegetative state. Six percent of the patients died, but only two of these patients (1.3%) died as direct result of their head injury. When the results for patients with Glasgow Coma Scale motor scores of >or=4 were compared with the periods 1980-1981 (preneurosurgical intensive care) and 1987-1988 (basic neurosurgical intensive care), mortality had decreased from 40% in the first period to 27% in the second period and to 2.8% in the present series. Favorable outcome in the same group of patients had increased steadily from 40% in the first period, to 68% in the second period, and finally, to 84% in the present series. CONCLUSIONS: The main observation in this hospital series of traumatic brain injury patients was a low rate of death directly caused by head injury and a high rate of favorable outcome. The comparison of patients with Glasgow Coma Scale motor scores of >or=4 with the previously reported results from the same unit indicate that substantial improvement in outcome has been achieved.

Adolescent↗

PubMedDate not supplied

CT appearance of diffuse mesenteric edema.

The extent of pathologic processes involving the mesentery is frequently difficult to assess by clinical examination and standard radiography. Contrast studies of the gastrointestinal tract only identify the effect of these processes on adjacent opacified bowel loops and frequently underestimate the extent of mesenteric pathology. Computed tomography has previously been used to characterize various mesenteric abnormalities, most often secondary to malignant or inflammatory disease. We report the characteristic CT appearance of diffuse mesenteric edema in 14 patients. Eleven patients had documented hypoalbuminemia, two patients superior mesenteric vein thrombosis, and one patient cirrhosis. The CT findings that allowed confident diagnosis of this entity include increase in density of the mesenteric fat, poor definition of segmental mesenteric vessels, relative sparing of the retroperitoneal fat, and association with subcutaneous edema.

Edema↗

PubMed1990

The natural history of lumbar intervertebral disc extrusions treated nonoperatively.

The purpose of this study was to evaluate the natural history of morphologic changes within the lumbar spine in patients who sustained lumbar disc extrusions. All patients in this study were treated nonoperatively for radicular pain and neurologic loss. The following questions were addressed: 1) Does perithecal or perineural fibrosis result when extrusions are not removed surgically, and 2) Do disc extrusions spontaneously resolve, and, if so, how rapidly? The study population consisted of 11 patients with extrusions and radiculopathy. All patients were successfully treated nonoperatively. All had a primary complaint of leg pain and all had positive straight leg raising reproducing their leg pain at less than or equal to 60 degrees. Additionally, 87% had muscle weakness on a neurologic basis in a root level distribution corresponding to the site of disc pathology. Computed tomographic (CT) examinations were obtained on all patients at the inception of treatment. These studies were compared with follow-up MRI studies. The initial CT scans were evaluated for the following criteria: disc size and position, thecal sac effacement, nerve root enlargement or displacement, and evidence of central or intervertebral canal stenosis. In addition to the pathomorphology evaluated on the CT scans, follow-up MRI studies also evaluated disc hydration at the herniated and contiguous levels, and the presence of perithecal or perineural fibrosis. The following grading system was used to evaluate change in fragment size on the follow-up studies: Grade 1-0 to 50% decrease in size; Grade 2-50 to 75% decrease in size; Grade 3-75 to 100% decrease in size.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed2003

Patients over 45 years with iron deficiency require investigation.

BACKGROUND: Iron deficiency anaemia (IDA) that occurs in patients above the age of 45 years is often caused by gastrointestinal blood loss, and guidelines on the appropriate investigation of these patients have been published. There are few data regarding patients with iron deficiency who are not anaemic and it is not clear how these patients should be managed. OBJECTIVES: We set out to investigate the hypothesis that similar pathologies are likely to underlie iron deficiency and IDA, and to assess whether IDA was being investigated according to the guidelines published by the British Society of Gastroenterology (BSG). METHODS: The pathology computer identified 153 consecutive patients over the age of 45 years who had serum ferritin levels below 20 microg/dl (normal range 20-200 microg/dl) in a 2 month period (i.e., October and November 2000). Medical records were examined and we recorded all investigations, the diagnoses reached, and the investigating specialty. The results were compared using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The study shows that the causes of iron deficiency and IDA are similar, but IDA is investigated more thoroughly than iron deficiency, OR 2.07 (CI 1.08-3.97). Ten patients with iron deficiency without anaemia were found to have coeliac disease, a significant result, OR 6.71 (CI 1.38-32.6). The majority of patients with IDA are not under the care of a gastroenterologist and this group are significantly less likely to be investigated according to the BSG guidelines, OR 0.15 (0.04-0.6). CONCLUSIONS: The study shows that the yield of investigation of iron deficiency is high and, hence, it should be investigated in all patients over the age of 45 years. Despite guidelines published by the BSG, IDA is investigated sub-optimally and measures other than the issuing of guidelines are needed to change practice.

Age Factors↗

PubMed2005

Prevalence of herpes simplex virus (types 1 and 2), varicella-zoster virus, cytomegalovirus, and human herpesvirus 6 and 7 DNA in cerebrospinal fluid of Middle Eastern patients with encephalitis.

HSV-1 DNA was detected in 32 (30%) of 106 cerebrospinal fluid samples from patients with encephalitis. Cytomegalovirus, varicella-zoster virus, and human herpesvirus 6 (HHV-6) DNAs were each detected in three patients (3%); herpes simplex virus type 2 (HSV-2) and HHV-7 PCRs were negative. HSV detection was associated with seizure (P = 0.02), especially focal seizure (P = 0.0002), and pathological computed tomography (P = 0.02) with focal lesions (P = 0.0004).

Adolescent↗

PubMed1999

Assessment of the feasibility of conducting population prevalence studies of chronic renal failure according to ethnic group: a survey of clinical biochemistry laboratories in Greater London and south east England.

The planning of renal replacement therapy is based on assessment of population need for the white population, but uses historical trends in treatment uptake for black and Asian ethnic minority groups, for whom the incidence of chronic renal failure (CRF) is not known. Epidemiological studies of CRF are based upon follow-up of plasma creatinine results obtained from clinical biochemistry laboratories. We conducted a postal questionnaire survey of UK National Health Service (NHS) and private clinical biochemistry laboratories in Greater London and the south east of England to arrange the design and test the feasibility of carrying out a study to determine ethnic-specific rates of CRF. Fifty-five NHS laboratories (90%) and 19 private laboratories (57%) responded. Few pathology computer systems recorded ethnic group, patient post code, or diagnosis; although 31 of the laboratory computers (42%) were linked with the hospital Patient Administration System which could supply these data. Approximately 5.5 million electrolyte profiles and 20 million individual renal function tests are carried out annually in south east England. Ninety per cent of those were performed within NHS laboratories, implying that a study can use NHS sources alone without risk of any undue bias. Sixty laboratories (81%) included creatinine in their routine electrolyte profile, which would be a requirement for any study. Thirty-one laboratories (42%) archived tests within 1 year of entry, which would rule out a retrospective study design. A prospective study is feasible and should be carried out as soon as is practicable.

Clinical Laboratory Information Systems↗

PubMed2001

High short-term mortality following lung biopsy for usual interstitial pneumonia.

Usual interstitial pneumonia (UIP) is a specific histological pattern of interstitial pneumonia most often associated with the clinical syndrome of idiopathic pulmonary fibrosis (IPF). There is controversy regarding the use of surgical lung biopsy in the diagnosis of UIP, and the risk of lung biopsy in these patients is largely unknown. This study investigated the 30 day surgical mortality rate in patients undergoing surgical lung biopsy for UIP. Patients undergoing surgical lung biopsy over a 10-yr period from 1986-1995 with the ultimate diagnosis of UIP (with or without underlying connective tissue disease) were identified. Pathology, computed tomography, medical records, and survival were assessed. Ten of sixty patients with usual interstitial pneumonia were found to be dead within 30 days of surgical biopsy. All of these were patients with idiopathic UIP, unassociated with connective tissue disease (clinical condition of IPF). In conclusion, patients with usual interstitial pneumonia of the idiopathic type, who present with atypical features, may be at higher risk for death following surgical biopsy than patients presenting with more typical features or patients with other interstitial illnesses.

Adult↗

PubMed2000

Smell and taste disorders: a primary care approach.

Smell and taste disorders are common in the general population, with loss of smell occurring more frequently. Although these disorders can have a substantial impact on quality of life and may represent significant underlying disease, they are often overlooked by the medical community. Patients may have difficulty recognizing smell versus taste dysfunction and frequently confuse the concepts of "flavor" and "taste." While the most common causes of smell disturbance are nasal and sinus disease, upper respiratory infection and head trauma, frequent causes of taste disturbance include oral infections, oral appliances (e.g., dentures), dental procedures and Bell's palsy. Medications can interfere with smell and taste, and should be reviewed in all patients with reported dysfunction. In addition, advancing age has been associated with a natural impairment of smell and taste ability. A focused history and a physical examination of the nose and mouth are usually sufficient to screen for underlying pathology. Computed tomographic scanning or magnetic resonance imaging of affected areas, as well as commercially available standardized tests, may be useful in selected patients. The causes of olfactory dysfunction that are most amenable to treatment include obstructing polyps or other masses (treated by excision) and inflammation (treated with steroids). Enhancement of food flavor and appearance can improve quality of life in patients with irreversible dysfunction.

Age Factors↗

PubMed2003

[Effects of cilazapril on the expression of vascular endothelial growth factor and intercellular adhesion molecule-1 in diabetic rat glomeruli].

OBJECTIVE: To assess the effect of cilazapril, an angiotensin-converting enzyme inhibitor (ACEI), on the protection against diabetic nephropathy and on the expression of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) in diabetic rat glomeruli. METHODS: The rat model of diabetes mellitus (DM) was produced by injection of streptozocin (STZ). After the treatment with cilazapril [1 mg/(kg.d)] for 2 weeks and 8 weeks, glomerular hypertrophy, renal function and 24 h urinary protein count were measured, and the expression of VEGF and ICAM-1 were investigated by immunohistochemical technique and Mias-2000 pathology computer image analyzer in diabetic rat glomeruli. RESULTS: At 2 weeks, kidney weight/body weight (KW/BW), creatinin clearance rate (CCr) and 24 hours urine protein count increased significantly in DM model group, compared with control (P < 0.05, P < 0.01). Meanwhile, by immunohistochemistry, increased levels of glomerular VEGF and ICAM-1 were shown and their peaks were seen at 8 weeks (P < 0.01). Cilazapril could reduce KW/BW, CCr and 24 hours urine protein count and significantly suppress the overexpression of VEGF and ICAM-1 in cilazapril treatment group after 8 weeks, compared with the DM model group(P < 0.05). CONCLUSION: Cilazapril can suppress the overproduction of two cytokines, VEGF and ICAM-1, thus preventing the progression of diabetic nephropathy.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2006

Imaging in patients with a first seizure.

Neuroimaging has important applications in the diagnosis and treatment of patients with seizures and epilepsy and can contribute to the proper classification of certain epileptic disorders. When a patient presents to the Accident and Emergency Department with a first seizure, the clinician may request brain imaging to determine the cause of the seizure. In new onset seizures or epilepsy with suspected focal pathology, computed tomography (CT) of the brain should be performed if the patient has not fully recovered or if magnetic resonance imaging (MRI) is not available within a reasonable time period. Otherwise, it is reasonable to forego CT and perform MRI. This report emphasises the need for appropriate imaging for accurate diagnosis of suspected new-onset partial epilepsy.

Adult↗

PubMed1991

Acute parapharyngeal space infections. A report of 12 cases.

Parapharyngeal space infections are a serious condition with a significant morbidity and mortality. Twelve cases seen between 1987 and 1990 are described. From the clinical findings it was clear that the tonsils appeared to be the most common source of infection and not other aetiological factors, such as dental and salivary gland pathology. Computed tomography was excellent in delineating the mass, but if this is not available ultrasonography appears to be of benefit. Intravenous antibiotics and the appropriate surgical intervention, when indicated, is the treatment of choice. An excellent clinical response was experienced; however, in 25% of patients recovery was complicated by aspiration pneumonia.

Acute Disease↗

PubMed1977

[Cerebellar dysarthria (author's transl)].

Dysarthria due to involvement of the cerebellum represents a facultative symptom of cerebellar disease. The mechanisms by which such dysarthrias are produced are unknown but may result from pathologic involvement of the entire cerebellum. The symptoms of cerebellar dysarthria in children and in adults are described in two case histories. Characteristic speech defects or dysarthrophony occur. In addition to speech pathology, computer tomography of the skull is useful in obtaining both differential diagnosis and an estimate of prognosis. The goal of treatment should be the improvement of muscle defects of tonus and coordination needed for speech, and can employ both physio- and ergotherapy.

Adult↗

PubMed1985

Correlations between radiography, ultrasonography, computed tomography and pathologic findings in prostatic disease.

A total of 20 macroscopically normal or hypertropic prostates were taken from cadavers of men older than fifty, who died of causes other than urologic ones. The samples were studied in vitro by nonscreen x-ray films, ultrasonography, computed tomography, and then by a pathologist. There were 4 normal prostates, 12 with benign prostatic hypertrophy, 3 with carcinoma, and 1 with prostatitis. Conventional radiography which showed only prostatic calcifications was of no pathologic interest. Computed tomography is by no means of diagnostic use in distinguishing between benign prostatic hypertrophy and carcinoma, and should be used only as an alternative in the evaluation of regional extension of prostatic carcinoma. On the other hand, ultrasonography appears to be sensitive to detection of very small nonpalpable nodules. However, its specificity is poor and its use should be restricted as a guide in obtaining biopsy specimens or as a means of evaluating tumor volume.

Aged↗

PubMed1986

Supratentorial ependymomas: computed tomographic and pathologic correlations.

Of a total of 52 cases of ependymomas, 38 were intracranial, with 15 being supratentorial and 23 infratentorial. Pre- and postoperative computed tomographic scans were correlated with surgical pathologic findings in four cases of supratentorial ependymomas. Pathologic specimens were analyzed from another four cases for which only postoperative scans were available. Seven cases had no computed tomographic studies, but pathology reports were available. Common computed tomography findings for these tumors included para- or intraventricular location, one or more cystic areas within the tumor, and calcifications within the lesion or around its periphery. Proven subependymal spread of tumor was evident by computed tomography in one case. Mixing of ependymoma with oligodendroglioma was present in four cases and with both oligodendroglioma and astrocytoma in two cases. Microscopic calcifications were more frequently seen in ependymomas that were mixed with oligodendroglioma.

Adolescent↗

PubMed2002

Diffuse pulmonary involvement by mycosis fungoides: high-resolution computed tomography and pathologic findings.

The authors report the high-resolution computed tomography (HRCT) appearance of diffuse pulmonary involvement by mycosis fungoides in a 74-year-old woman whose clinical and radiographic manifestations simulated pneumonia. The HRCT showed multiple, dense, peribronchovascular nodules with surrounding ground-glass opacity and several wedge-shape peripheral opacities. The autopsy specimen revealed angiocentric and peribronchovascular involvement of mycosis fungoides and pulmonary infarctions distal to angiocentric infiltration of the tumor cells.

Aged↗

PubMed1988

Computers in anatomic pathology. A survey of California hospitals.

The anatomic pathology services of 434 health care institutions in California were surveyed about their use of computers. Of 200 (46%) respondents, 106 (53%) did not use computers at all. Of 94 (47%) respondents who used computers, 77 (82%) used them for administrative purposes; 74 (79%), for any routine processing of surgical specimens; 43 (45%), for processing surgical specimens other than word processing (eg, database); 52 (55%), for processing cytology specimens; and 60 (63%), for processing autopsy specimens (including word processing). Computer use was slightly greater with higher work loads. Among nonusers, on a scale of 1 to 5 the average interest in using computers was 3.5 for surgical pathology data, 3.4 for cytology data, and 2.8 for autopsy data. The interest rate also increased with work load, and was nearly 4 for laboratories with greater than 4000 surgical or cytology cases per year. The average interest in controlling and/or making decisions about computer hardware and software was 3.9 for hardware and 4 for software. Reasons for low computer use in anatomic pathology despite interest in utilization are discussed, including the limited selection of affordable commercial software for anatomic pathology and difficulties of in-house software development.

Autopsy↗