1
|
Knight J, Kamaya A, Fetzer D, Dahiya N, Gabriel H, Rodgers SK, Tublin M, Walsh A, Bingham D, Middleton W, Fung C. Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines. Abdom Radiol (NY) 2024:10.1007/s00261-024-04197-9. [PMID: 38411693 DOI: 10.1007/s00261-024-04197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14 mm 'extremely low risk' or '7-14 mm' low risk polyps that decrease in size by ≥ 4 mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.
Collapse
Affiliation(s)
- Jessica Knight
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - David Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Scottsdale, Phoenix, AZ, 85259, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Andrew Walsh
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - David Bingham
- Department of Pathology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| |
Collapse
|
2
|
Mudd P, Borcherding N, Kim W, Quinn M, Han F, Zhou J, Sturtz A, Schmitz A, Lei T, Schattgen S, Klebert M, Suessen T, Middleton W, Goss C, Liu C, Crawford J, Thomas P, Teefey S, Presti R, O'Halloran J, Turner J, Ellebedy A. Antigen-specific CD4 + T cells exhibit distinct transcriptional phenotypes in the lymph node and blood following vaccination in humans. Res Sq 2023:rs.3.rs-3304466. [PMID: 37790414 PMCID: PMC10543502 DOI: 10.21203/rs.3.rs-3304466/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
SARS-CoV-2 infection and mRNA vaccination induce robust CD4+ T cell responses that are critical for the development of protective immunity. Here, we evaluated spike-specific CD4+ T cells in the blood and draining lymph node (dLN) of human subjects following BNT162b2 mRNA vaccination using single-cell transcriptomics. We analyze multiple spike-specific CD4+ T cell clonotypes, including novel clonotypes we define here using Trex, a new deep learning-based reverse epitope mapping method integrating single-cell T cell receptor (TCR) sequencing and transcriptomics to predict antigen-specificity. Human dLN spike-specific T follicular helper cells (TFH) exhibited distinct phenotypes, including germinal center (GC)-TFH and IL-10+ TFH, that varied over time during the GC response. Paired TCR clonotype analysis revealed tissue-specific segregation of circulating and dLN clonotypes, despite numerous spike-specific clonotypes in each compartment. Analysis of a separate SARS-CoV-2 infection cohort revealed circulating spike-specific CD4+ T cell profiles distinct from those found following BNT162b2 vaccination. Our findings provide an atlas of human antigen-specific CD4+ T cell transcriptional phenotypes in the dLN and blood following vaccination or infection.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Goss
- Division of Biostatistics, Washington University in St.Louis
| | - Chang Liu
- Washington University School of Medicine
| | | | | | | | | | - Jane O'Halloran
- Department of Emergency Medicine, Washington University in St.Louis
| | | | | |
Collapse
|
3
|
Zulfiqar M, Calhoun B, Shetty A, Jyoti A, Middleton W. Optimization of Patient Positioning for the Sonographic Evaluation of Gallstone Impaction: Analysis of Gallbladder Orientation Based on Computed Tomography. Ultrasound Q 2022; 38:341-345. [PMID: 36103429 DOI: 10.1097/ruq.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT An important sonographic sign of cholecystitis is stone impaction in the gallbladder neck. Demonstration of stone mobility excludes impaction. The purpose of this study is to analyze the orientation of the gallbladder on computed tomography and determine the patient position most likely to facilitate stone mobility. ImageJ processing software was used to determine the x (transverse), y (anterior-posterior), and z (craniocaudal) coordinates for the gallbladder neck and fundus in 544 consecutive computed tomography examinations. The differences in the fundal and neck coordinates were used to determine the likelihood of moving a stone from the neck to the fundus for the left and right lateral decubitus positions ( x coordinates), the prone position ( y coordinates), and the upright position ( z coordinates). The coordinate with the largest difference was considered to predict the position most likely to facilitate stone motion. The difference in position of the fundus and neck was greatest in the y -, z -, and x -axis in 232 (42.6%), 194 (35.7%), and 118 (21.7%) of patients, respectively. For body mass index (BMI) less than 25 kg/m 2 , the difference was greatest in the z -axis (59.8%). For BMI greater than 25 kg/m 2 , the difference was greatest in the y -axis (47.1%). Based on their relative location, the optimal position to facilitate gallstone mobility from the gallbladder neck to fundus was most often prone (especially in high BMI patients), followed by upright (especially in low BMI patients), followed by right lateral decubitus. The left lateral decubitus position was never optimal.
Collapse
Affiliation(s)
- Maria Zulfiqar
- Department of Abdominal Imaging, Mayo Clinic, Phoenix, AZ
| | - Brendan Calhoun
- Department of Abdominal Imaging, Mallinckrodt Institute of Radiology
| | - Anup Shetty
- Department of Abdominal Imaging, Mallinckrodt Institute of Radiology
| | - Arora Jyoti
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO
| | - William Middleton
- Department of Abdominal Imaging, Mallinckrodt Institute of Radiology
| |
Collapse
|
4
|
Amidi E, Yang G, Uddin KMS, Luo H, Middleton W, Powell M, Siegel C, Zhu Q. Role of blood oxygenation saturation in ovarian cancer diagnosis using multi-spectral photoacoustic tomography. J Biophotonics 2021; 14:e202000368. [PMID: 33377620 PMCID: PMC8044001 DOI: 10.1002/jbio.202000368] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 05/05/2023]
Abstract
In photoacoustic tomography (PAT), a tunable laser typically illuminates the tissue at multiple wavelengths, and the received photoacoustic waves are used to form functional images of relative total haemoglobin (rHbT) and blood oxygenation saturation (%sO2 ). Due to measurement errors, the estimation of these parameters can be challenging, especially in clinical studies. In this study, we use a multi-pixel method to smooth the measurements before calculating rHbT and %sO2 . We first perform phantom studies using blood tubes of calibrated %sO2 to evaluate the accuracy of our %sO2 estimation. We conclude by presenting diagnostic results from PAT of 33 patients with 51 ovarian masses imaged by our co-registered PAT and ultrasound system. The ovarian masses were divided into malignant and benign/normal groups. Functional maps of rHbT and %sO2 and their histograms as well as spectral features were calculated using the PAT data from all ovaries in these two groups. Support vector machine models were trained on different combinations of the significant features. The area under ROC (AUC) of 0.93 (0.95%CI: 0.90-0.96) on the testing data set was achieved by combining mean %sO2 , a spectral feature, and the score of the study radiologist.
Collapse
Affiliation(s)
- Eghbal Amidi
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Guang Yang
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - K. M. Shihab Uddin
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Hongbo Luo
- Department of Electrical and System Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - William Middleton
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Powell
- Division of Gynecological Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Cary Siegel
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
5
|
Bolívar HA, Elliott RJ, Middleton W, Yoon JH, Okoli CTC, Haliwa I, Miller CC, Ades PA, Gaalema DE. Social Smoking Environment and Associations With Cardiac Rehabilitation Attendance. J Cardiopulm Rehabil Prev 2021; 41:46-51. [PMID: 32925296 PMCID: PMC7755730 DOI: 10.1097/hcr.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Continued cigarette smoking after a major cardiac event predicts worse health outcomes and leads to reduced participation in cardiac rehabilitation (CR). Understanding which characteristics of current smokers are associated with CR attendance and smoking cessation will help improve care for these high-risk patients. We examined whether smoking among social connections was associated with CR participation and continued smoking in cardiac patients. METHODS Participants included 149 patients hospitalized with an acute cardiac event who self-reported smoking prior to the hospitalization and were eligible for outpatient CR. Participants completed a survey on their smoking habits prior to hospitalization and 3 mo later. Participants were dichotomized into two groups by the proportion of friends or family currently smoking ("None-Few" vs "Some-Most"). Sociodemographic, health, secondhand smoke exposure, and smoking measures were compared using t tests and χ2 tests (P < .05). ORs were calculated to compare self-reported rates of CR attendance and smoking cessation at 3-mo follow-up. RESULTS Compared with the "None-Few" group, participants in the "Some-Most" group experienced more secondhand smoke exposure (P < .01) and were less likely to attend CR at follow-up (OR = 0.40; 95% CI, 0.17-0.93). Participants in the "Some-Most" group tended to be less likely to quit smoking, but this difference was not statistically significant. CONCLUSION Social environments with more smokers predicted worse outpatient CR attendance. Clinicians should consider smoking within the social network of the patient as an important potential barrier to pro-health behavior change.
Collapse
Affiliation(s)
- Hypatia A Bolívar
- Vermont Center on Behavior and Health (Drs Bolívar, Ades, and Gaalema, Ms Elliott, and Mr Middleton) and Departments of Psychiatry (Drs Bolívar and Gaalema and Ms Elliott) and Psychology (Mr Middleton and Dr Gaalema), University of Vermont, Burlington; Departments of Psychiatry and Behavioural Sciences (Dr Yoon and Ms Haliwa) and Cardiothoracic and Vascular Surgery (Dr Miller), University of Texas Health Science at Houston; College of Nursing, University of Kentucky, Lexington (Dr Okoli); and Division of Cardiology, University of Vermont College of Medicine, Burlington (Dr Ades)
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
Background: Thyroid nodules are routinely evaluated with ultrasound. Isthmic nodules carry higher risk of malignancy (in press). Surgical studies suggest higher risk of metastasis from thyroid cancer located in isthmus region. In this study, we evaluate how adding an extra point for isthmic location to current ACR-TIRADS will affect the sensitivity and specificity to predict thyroid cancer. Methods: We performed a subanalysis of isthmic nodules contained in a retrospectively created database of 3313 adult patients from six referral centers with confirmed benign or malignant nodules. Sensitivity and specificity were calculated using the current ACR TI-RADS scoring system and compared to a system that would add an extra point based on nodule location in the isthmus. Results: There were 195 nodules in the isthmus (34 malignant). If a recommendation for FNA was considered a positive test result, the sensitivity and specificity would be 50% (17/34) and 61% (99/161) respectively using current ACR TI-RADS scoring. If an additional point was added the sensitivity and specificity would be 62% (21/34) and 36% (58/161) respectively. Adding the additional point would lead to detection of 4 additional malignant nodules at the cost of biopsying 41 additional benign nodules. If a recommendation for either FNA or follow-up ultrasound for 5 years was considered a positive test result, the sensitivity and specificity would be 82% (28/34) and 35% (56/161) respectively using current ACR TI-RADS scoring. If an additional point was added the sensitivity and specificity would be 94% (32/34) and 15% (24/161) respectively. Adding the additional point would lead to detection of 4 additional malignant nodules at the cost of either biopsying or following 32 additional benign nodules. Conclusions: Isthmic nodules are more likely to be malignant than nodules in other locations. When using the ACR TI-RADS, adding a point for isthmic nodules improves detection of cancer with a moderate increase in the rate of FNA and follow-up of benign nodules. Given the higher risk of extra thyroidal extension and nodal metastases for isthmic cancers, this tradeoff between sensitivity and specificity may be acceptable and should be considered when dealing with nodules in the isthmus. Keywords: thyroid nodule, ACR TI-RADS, location, isthmus, thyroid cancer
Collapse
Affiliation(s)
- Sina Jasim
- Washington University in St Louis, Saint Louis, MO, USA
| | | | - Sharlene Teefey
- Mallinckrodt Institute of Radiology, Washington University in St Louis, Saint Louis, MO, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University in St Louis, Saint Louis, MO, USA
| |
Collapse
|
7
|
Tang CT, Decker G, Steger-May K, Middleton W, Teefey S. Method Comparison for Detection and Measurement of Rotator Cuff Tears: Office-based Bedside Ultrasonography by a Single Physiatrist versus Imaging Center-based Ultrasonography by Two Expert Musculoskeletal Radiologists. PM R 2019; 12:563-572. [PMID: 31583842 DOI: 10.1002/pmrj.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION There is increasing interest among physiatrists in using bedside ultrasonography to assess rotator cuff tears. OBJECTIVE To conduct a method comparison between ultrasonography performed by a single physiatrist at bedside and two validated expert musculoskeletal radiologists at an imaging center. DESIGN Prospective, blinded comparison study. SETTING Academic outpatient clinic and imaging center. PATIENTS Seventy-two unilateral shoulders were scanned. Inclusion criteria included pain or weakness with rotator cuff testing and compliance with repeat ultrasonography. INTERVENTIONS Ultrasonography performed by the physiatrist was done at bedside during the patient's clinical visit, while the radiologists' scan was performed afterwards in an imaging center. The radiologists trained the physiatrist who was performing the scans. MAIN OUTCOME MEASUREMENTS The primary outcome was integrity of the rotator cuff (intact, partial tear, full tear). When a posterior cuff (supraspinatus, infraspinatus, teres minor) tear was detected, measurements of length, width, and distance from the biceps tendon were taken. RESULTS With use of the radiologists' scan as a criterion standard, bedside ultrasonography performed by the physiatrist for detection of posterior cuff tears had a percent perfect agreement of 72.2% for categorization as no tear, partial tear, or full tear. When evaluating dichotomously for presence of a full tear, sensitivity was 82.1% and specificity was 93.9%. Seven (18%) full-thickness tears were missed, and all were essentially small (<15 mm). When physiatrist and radiologist measurements were compared, the mean ± standard deviation (SD) difference in length was 3.4 ± 4.7 mm, width was 2.7 ± 6.7 mm, and distance to the biceps tendon was -0.8 ± 7.5 mm. CONCLUSIONS Office-based bedside ultrasonography is a reasonable modality to rule out medium/large full-thickness posterior cuff tears. However, physicians should be aware that a percentage of small full-thickness tears can be missed. Further imaging should be considered in suspected partial tears and full tears that may be appropriate for surgical repair.
Collapse
Affiliation(s)
- Chi-Tsai Tang
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gregory Decker
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - William Middleton
- Division of Diagnostic Radiology, Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Sharlene Teefey
- Division of Diagnostic Radiology, Department of Radiology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
8
|
Amidi E, Mostafa A, Nandy S, Yang G, Middleton W, Siegel C, Zhu Q. Classification of human ovarian cancer using functional, spectral, and imaging features obtained from in vivo photoacoustic imaging. Biomed Opt Express 2019; 10:2303-2317. [PMID: 31149374 PMCID: PMC6524604 DOI: 10.1364/boe.10.002303] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 05/03/2023]
Abstract
We report in this pilot study the diagnostic results of in vivo imaging of patients with ovarian lesions, using a co-registered photoacoustic and ultrasound (PAT/US) system. A total of 39 ovaries from 24 patients were imaged in vivo. PAT functional features, i.e., blood oxygen saturation (sO2) and relative total hemoglobin (rHbT), PAT image features, and PAT spectral features within a region of interest (ROI) in each ovarian tissue were extracted. To select the significant features, a t-test on each feature was performed, and the independent predictors were determined by evaluating correlation between each pair of predictors. To classify the ovarian lesions, we employed a generalized linear model (GLM) and a support vector machine (SVM). We used these classifiers first to distinguish benign/normal lesions from ovaries with invasive epithelial tumors and then to separate normal/benign lesions from all types of ovarian tumors. We developed classifiers once by inclusion of PAT functional features to assess the best diagnostic performance of the classifiers when multiple wavelengths data are available. Second time, we excluded the PAT functional features from the features set to evaluate the best diagnostic performance if only a single wavelength is available. Our results show that using functional features improves the classification performance, especially for distinguishing normal/benign ovarian lesions from all types of tumors. In this case, an area under ROC curve (AUC) of 0.92, 0.93 of testing data was achieved using a GLM and SVM classifier when functional features were included in the feature set while excluding these features resulted in an AUC of 0.89, 0.92, respectively.
Collapse
Affiliation(s)
- Eghbal Amidi
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Atahar Mostafa
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sreyankar Nandy
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Guang Yang
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - William Middleton
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Cary Siegel
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| |
Collapse
|
9
|
Abstract
Ultrasound is the imaging modality of choice to evaluate the scrotum because of its high resolution, Doppler capabilities, availability, and lack of ionizing radiation. Acute urologic emergencies diagnosed with ultrasound include testicular torsion, testicular rupture, and Fournier gangrene. The radiologist's knowledge of sonographic features of vascular, infectious, traumatic, and benign and malignant processes that occur in the scrotum coupled with the patient's presenting symptoms, age, and physical examination allows for the correct diagnosis of a wide spectrum of scrotal pathology.
Collapse
Affiliation(s)
- Kristin Rebik
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA.
| | - Jason M Wagner
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| |
Collapse
|
10
|
Hebert-Davies J, Teefey SA, Steger-May K, Chamberlain AM, Middleton W, Robinson K, Yamaguchi K, Keener JD. Progression of Fatty Muscle Degeneration in Atraumatic Rotator Cuff Tears. J Bone Joint Surg Am 2017; 99:832-839. [PMID: 28509823 PMCID: PMC5426399 DOI: 10.2106/jbjs.16.00030] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this prospective study was to examine the progression of fatty muscle degeneration over time in asymptomatic shoulders with degenerative rotator cuff tears. METHODS Subjects with an asymptomatic rotator cuff tear in 1 shoulder and pain due to rotator cuff disease in the contralateral shoulder were enrolled in a prospective cohort. Subjects were followed annually with shoulder ultrasonography, which evaluated tear size, location, and fatty muscle degeneration. Tears that were either full-thickness at enrollment or progressed to a full-thickness defect during follow-up were examined. A minimum follow-up of 2 years was necessary for eligibility. RESULTS One hundred and fifty-six shoulders with full-thickness rotator cuff tears were potentially eligible. Seventy shoulders had measurable fatty muscle degeneration of at least 1 rotator cuff muscle at some time point. Patients with fatty muscle degeneration in the shoulder were older than those without degeneration (mean, 65.8 years [95% confidence interval (CI), 64.0 to 67.6 years] compared with 61.0 years [95% CI, 59.1 to 62.9 years]; p < 0.05), and the median size of the tears at baseline was larger in shoulders with degeneration than in shoulders that did not develop degeneration (13 and 10 mm wide, respectively, and 13 and 10 mm long; p < 0.05). Tears with fatty muscle degeneration were more likely to have enlarged during follow-up than were tears that never developed muscle degeneration (79% compared with 58%; odds ratio, 2.64 [95% CI, 1.29 to 5.39]; p < 0.05). Progression of fatty muscle degeneration occurred more frequently in shoulders with tears that had enlarged (43%; 45 of 105) than in shoulders with tears that had not enlarged (20%; 10 of 51; p < 0.05). Additionally, tears with enlargement and progression of muscle degeneration were more likely to extend into the anterior supraspinatus than were those without progression (53% and 17%, respectively; p < 0.05); however, this relationship was lost when controlling for tear size (p = 0.56). The median time from tear enlargement to progression of fatty muscle degeneration was 1.0 year (range, -2.0 to 6.9 years) for the supraspinatus and 1.1 years (range, -1.8 to 8.5 years) for the infraspinatus muscle (p = 0.98). CONCLUSIONS Progression of fatty muscle degeneration is more common in tears that are larger at baseline, enlarge over time, and undergo a larger magnitude of enlargement. Our study findings also suggest that an often rapid progression of muscle degeneration occurs in relation to a clinically relevant increase in tear size in some degenerative cuff tears. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Jonah Hebert-Davies
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri,E-mail address for J. Hebert-Davies:
| | - Sharlene A. Teefey
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron M. Chamberlain
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Kathryn Robinson
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Ken Yamaguchi
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Jay D. Keener
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| |
Collapse
|
11
|
Abstract
Palpable soft tissue masses are common and are often referred for imaging evaluation. Ultrasonography is an attractive way to image these lesions because it is inexpensive, readily available, and does not rely on ionizing radiation. Ultrasonography can easily confirm the presence of a mass, differentiate solid from cystic lesions, define the anatomic extent of the lesion, and detect vascular lesions with high sensitivity. In most cases, ultrasonography can accurately characterize the lesion, obviating biopsy and reducing unnecessary further work-up. This article reviews the capabilities of ultrasonography in evaluating superficial soft tissue lesions and the sonographic appearance of disease entities.
Collapse
Affiliation(s)
- Paul DiDomenico
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| |
Collapse
|
12
|
Affiliation(s)
- Paul DiDomenico
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
| |
Collapse
|
13
|
Rogowski P, Terrill E, Otero M, Hazard L, Middleton W. Ocean outfall plume characterization using an Autonomous Underwater Vehicle. Water Sci Technol 2013; 67:925-933. [PMID: 23306274 DOI: 10.2166/wst.2012.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A monitoring mission to map and characterize the Point Loma Ocean Outfall (PLOO) wastewater plume using an Autonomous Underwater Vehicle (AUV) was performed on 3 March 2011. The mobility of an AUV provides a significant advantage in surveying discharge plumes over traditional cast-based methods, and when combined with optical and oceanographic sensors, provides a capability for both detecting plumes and assessing their mixing in the near and far-fields. Unique to this study is the measurement of Colored Dissolved Organic Matter (CDOM) in the discharge plume and its application for quantitative estimates of the plume's dilution. AUV mission planning methodologies for discharge plume sampling, plume characterization using onboard optical sensors, and comparison of observational data to model results are presented. The results suggest that even under variable oceanic conditions, properly planned missions for AUVs equipped with an optical CDOM sensor in addition to traditional oceanographic sensors, can accurately characterize and track ocean outfall plumes at higher resolutions than cast-based techniques.
Collapse
Affiliation(s)
- Peter Rogowski
- Scripps Institution of Oceanography, La Jolla, CA 92093-0213, USA.
| | | | | | | | | |
Collapse
|
14
|
Rogowski P, Terrill E, Otero M, Hazard L, Middleton W. Mapping ocean outfall plumes and their mixing using autonomous underwater vehicles. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/2011jc007804] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
15
|
Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am 2009; 91:1055-62. [PMID: 19411453 DOI: 10.2106/jbjs.g.00118] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Partial-thickness rotator cuff tears are a common cause of shoulder pain, yet the appropriate surgical treatment is controversial. In particular, very little information is available regarding rotator cuff integrity after operative repair. The purpose of this study was to evaluate the functional outcome and anatomic healing rate after arthroscopic repair of high-grade partial (>50%) thickness tears of the supraspinatus tendon. METHODS Forty-one consecutive patients (forty-two shoulders) who had undergone arthroscopic conversion of a partial-thickness rotator cuff tear to a full-thickness tear and subsequent repair were evaluated with ultrasound for evidence of rotator cuff healing. Clinical outcomes were assessed with use of validated outcomes measures, and all patients were reexamined by an independent observer. RESULTS The average patient age was fifty-three years. Thirty-seven (88%) of the forty-two shoulders had an intact rotator cuff repair seen on ultrasound at an average of eleven months postoperatively. The remaining five patients had a full-thickness defect in the tendon. The mean American Shoulder and Elbow Surgeons (ASES) score improved from 46.1 points preoperatively to 82.1 points at the time of follow-up. The overall rate of patient satisfaction was 93%. The average age of the patients with an intact rotator cuff was 51.8 years compared with 62.6 years for those with a persistent defect (p = 0.02). CONCLUSIONS Arthroscopic repair of high-grade partial-thickness rotator cuff tears results in a high rate of tendon healing. Patient age is an important factor in tendon healing.
Collapse
Affiliation(s)
- Ganesh Kamath
- Department of Orthopaedic Surgery, Shoulder and Elbow Service, Washington University, St Louis, MO 63110, USA
| | | | | | | | | | | |
Collapse
|
16
|
Affiliation(s)
- Sanjiv Bajaj
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA.
| | | | | | | |
Collapse
|
17
|
|
18
|
|
19
|
|
20
|
Abstract
In August 1908 Karl August Bier, Professor of Surgery in Berlin, described a new method of producing analgesia of a limb which he named 'vein anesthesia'. Bier first presented his new method of intravenous regional anesthesia (IVRA) at the 37th Congress of the German Surgical Society on 22 April, 1908, only 10 years after his significant communication on spinal anesthesia (1). His method, which now bears his name, consisted of occluding the circulation in a segment of the arm with two tourniquets and then injecting a dilute local anesthetic through a venous cut-down in the isolated segment. Bier had the good fortune to use procaine, the first safe injectable local anesthetic that had been synthesized by Einhorn in 1904.
Collapse
Affiliation(s)
- S Brill
- Department of Anesthesiology and Intensive Care, Chaim Sheba Medical Center, Tel. Hashomer, Israel, 52621.
| | | | | | | |
Collapse
|
21
|
Lee DI, Andreoni CR, Rehman J, Landman J, Ragab M, Yan Y, Chen C, Shindel A, Middleton W, Shalhav A, McDougall EM, Clayman RV. Laparoscopic cyst decortication in autosomal dominant polycystic kidney disease: impact on pain, hypertension, and renal function. J Endourol 2003; 17:345-54. [PMID: 12965058 DOI: 10.1089/089277903767923100] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE In patients with autosomal dominant polycystic kidney disease (ADPKD), laparoscopic cyst decortication (LCD) has been proposed as a means to relieve chronic cyst-related pain. We present our 7-year experience with LCD for ADPKD with regard to pain relief, hypertension, and renal function. PATIENTS AND METHODS Between August 1994 and February 2001, 29 ADPKD patients with chronic pain (N=29), hypertension (N=21), and renal insufficiency (N=10) underwent 35 LCD procedures. Every detectable cyst within 2 mm of the renal surface was treated. Pain relief was assessed using a pain analog scale; relative pain relief (RPR) equaled (preoperative pain score) - (postoperative pain score)/(preoperative pain score). Hypertension was evaluated using the antihypertensive therapeutic index (ATI): [(dose of blood pressure medication 1/max dose 1) + (dose med 2/max dose 2) + etc.] x 10. Renal function was assessed using the Cockcroft and Gault formula for creatinine clearance. RESULTS The mean operating room time was 4.9 hours (range 2.6-6.6 hours) with no conversions to open surgery. An average of 220 cysts (range 4-692) were treated per patient. The mean follow-up was 32.3 months (range 6-72 months). The RPR was 58%, 47%, and 63% at 12, 24, and 36 months, respectively. At 12, 24, and 36 months, 73%, 52%, and 81% of patients, respectively, noted >50% improvement in their pain compared with the preoperative situation. Five patients became normotensive, and patients improved their ATI by an average of 49% (range 11%-93%). However, six patients had worsening hypertension, with an ATI increase averaging 53% (range 11%-122%), and one patient who was not hypertensive preoperatively has since developed hypertension. The creatinine clearance changed +4%, +7%, and -2% at 12, 24, and 36 months, respectively. Only one patient had a >20% increase in creatinine clearance. The only patients with a >20% decrease in creatinine clearance were those who had a creatinine clearance <30 mg/dL preoperatively (average decrease 34% [range 20%-51%]). CONCLUSIONS For ADPKD patients with debilitating pain, extensive LCD can provide durable relief. In the majority of patients with pain and hypertension, a marked improvement in blood pressure also occurs. Cyst decortication was not associated with worsening renal function; indeed, renal function remained largely unchanged over the 3-year follow-up period.
Collapse
Affiliation(s)
- David I Lee
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Electric interference by cautery on demand pacemakers can cause inhibition and loss of pacing. We report a case in which electrocautery induced a pacemaker in ventricle-paced, ventricle-sensed, inhibited, rate-responsive (VVIR) mode to pace at a programmed maximum rate of 130 pulses/min.
Collapse
Affiliation(s)
- D T Wong
- Department of Anesthesiology, University of Toronto, Canada.
| | | |
Collapse
|
23
|
Nightingale AJ, Middleton W, Middleton SJ, Hunter JO. Evaluation of the effectiveness of a specialist nurse in the management of inflammatory bowel disease (IBD). Eur J Gastroenterol Hepatol 2000; 12:967-73. [PMID: 11007131 DOI: 10.1097/00042737-200012090-00001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To determine the effect of a specialist nurse on the management outcome of patients with inflammatory bowel disease (IBD). DESIGN Audit of the management of a cohort of patients in the year prior to the employment of the specialist nurse and the year immediately after. SUBJECTS 339 patients, both male and female, with either Crohn's disease or ulcerative colitis, resident in the Cambridge health district. SETTING Addenbrooke's Hospital NHS Trust Outpatient Centre. MAIN OUTCOME MEASURE Health status was measured by blood tests (C-reactive protein, albumin and haemoglobin) throughout the year, symptom indices, number of clinic attendances, admissions to hospital and length of stay. Quality of life was measured via a postal questionnaire. RESULTS Hospital visits were reduced from 1377 to 853 (38% reduction) and in-patient length of stay measured in bed-days from 516 to 417 (19% reduction). The number of patients in remission increased from 63 to 69%. Patient satisfaction improved in key areas, in particular, access to information on IBD and advice on avoidance of illness and maintaining health. Of a total of 251 calls to the telephone helpline, only 19 patients were referred for a medical opinion and five patients required hospital admission. CONCLUSION The IBD nurse specialist is a valuable and cost-effective member of the gastroenterology team.
Collapse
Affiliation(s)
- A J Nightingale
- Department of Gastroenterology, Addenbrooke's NHS Trust, Cambridge, UK
| | | | | | | |
Collapse
|
24
|
|
25
|
Abstract
OBJECTIVE Series of patients fulfilling diagnostic criteria for Dissociative Identity Disorder (DID), otherwise known as multiple personality disorder, have particularly been reported on in North America and increasingly in other countries. The present study investigated the trauma and past treatment histories, symptom profiles and dissociative phenomenology of 62 patients fulfilling diagnostic criteria for DID seen in Brisbane (Queensland, Australia). METHOD From 1992, systematic assessments, including the Dissociative Experience Scale and the Dissociative Disorders Interview Schedule, were performed with a personal series of 57 patients with DID seen by one of the authors (WM) and five patients seen by the second author (JB). RESULTS The histories of childhood trauma, the clinical profiles and dissociative indices of these patients closely approximate those described in series reported in other countries. CONCLUSIONS Patients fulfilling diagnostic criteria for DID are regularly seen in Australian inpatient and outpatient settings. The dissociative symptomatology of the patients examined in the present study represents a significant component of a complex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.
Collapse
Affiliation(s)
- W Middleton
- Dissociative Disorders Unit, Belmont Private Hospital, Carina, Queensland, Australia
| | | |
Collapse
|
26
|
Middleton W, Raphael B, Burnett P, Martinek N. A longitudinal study comparing bereavement phenomena in recently bereaved spouses, adult children and parents. Aust N Z J Psychiatry 1998; 32:235-41. [PMID: 9588303 DOI: 10.3109/00048679809062734] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The study investigated previous research findings and clinical impressions which indicated that the intensity of grief for parents who had lost a child was likely to be higher than that for widows/widowers, who in turn were likely to have more intense reactions than adult children losing a parent. METHOD In order to compare the intensities of the bereavement reactions among representative community samples of bereaved spouses (n = 44), adult children (n = 40) and parents (n = 36), and to follow the course of such phenomena, a detailed Bereavement Questionnaire was administered at four time points over a 13-month period following the loss. RESULTS Measures based on items central to the construct of bereavement showed significant time and group differences in accordance with the proposed hypothesis. More global items associated with the construct of resolution showed a significant time effect, but without significant group differences. CONCLUSIONS Evidence from this study supports the hypothesis that in non-clinical, community-based populations the frequency with which core bereavement phenomena are experienced is in the order: bereaved parents > bereaved spouses > bereaved adult children.
Collapse
Affiliation(s)
- W Middleton
- Centre for Mental Health, NSW Health Department, Sydney, Australia
| | | | | | | |
Collapse
|
27
|
Gilfillan A, Warner JP, Kirk JM, Marshall T, Greening A, Ho LP, Hargreave T, Stack B, McIntyre D, Davidson R, Dean JC, Middleton W, Brock DJ. P67L: a cystic fibrosis allele with mild effects found at high frequency in the Scottish population. J Med Genet 1998; 35:122-5. [PMID: 9507391 PMCID: PMC1051215 DOI: 10.1136/jmg.35.2.122] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Only three mutant cystic fibrosis (CF) alleles have to date been established as conferring a dominant mild effect on affected subjects who are compound heterozygotes. We now add a fourth, P67L, which occurs on about 1.4% of Scottish CF chromosomes. Among 13 patients (12 unrelated) with this allele, the average age at diagnosis was 22.5 +/- 11.3 years. None of the cases had consistently raised sweat chloride concentrations, the average value being 57 +/- 9 mmol/l; 77% of the patients were pancreatic sufficient. When compared to three other established mild CF alleles, R117H, A455E, and 3849 + 10kb C-T, a compound heterozygote for P67L has minimal disease and clinical suspicions are unlikely to be confirmed other than by DNA typing.
Collapse
Affiliation(s)
- A Gilfillan
- Human Genetics Unit, University of Edinburgh, Western General Hospital, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Blam O, Bindra R, Middleton W, Gelberman R. The occult dorsal carpal ganglion: usefulness of magnetic resonance imaging and ultrasound in diagnosis. Am J Orthop (Belle Mead NJ) 1998; 27:107-10. [PMID: 9506195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Both magnetic resonance imaging and ultrasonography of the wrist have been advocated for the diagnosis of occult dorsal carpal ganglia. This clinical series compares the utility of the two techniques for confirming clinical suspicion of such occult ganglia. Four wrists in three patients with suspected occult dorsal ganglia were identified prospectively over a 12-month period. Each patient underwent imaging with both techniques on the same day. Subsequently, the wrist was operatively explored and the excised tissue was microscopically evaluated. All wrists in this series had positive magnetic resonance imaging and ultrasound findings, with operative and histologic confirmation of the diagnosis. No diagnostic advantage of one imaging study over the other was identified. With its lower cost and lack of contraindications, ultrasound may be the more suitable technique for establishing the diagnosis of occult dorsal carpal ganglion when clinical findings are inconclusive.
Collapse
Affiliation(s)
- O Blam
- Department of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | |
Collapse
|
29
|
Cox PN, Frndova H, Tan PS, Nakamura T, Miyasaka K, Sakurai Y, Middleton W, Mazer D, Bryan AC. Concealed air leak associated with large tidal volumes in partial liquid ventilation. Am J Respir Crit Care Med 1997; 156:992-7. [PMID: 9310024 DOI: 10.1164/ajrccm.156.3.9608049] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Current ventilator strategies aim at maintaining an open lung and limiting both peak inspiratory pressures and tidal volumes to avoid alveolar distension. Perfluorocarbons, as well as being excellent solvents for oxygen and carbon dioxide, have the unique properties of being able to recruit dependent lung regions and improve pulmonary mechanics. Optimal ventilator strategies for partial liquid ventilation (PLV) have not yet been clearly defined. In the surfactant-depleted rabbit model, an approach involving a large tidal volume (VT) (15 ml/kg) and lung filled to FRC with perfluorocarbon (PFC) was compared with strategies involving a moderate VT (9 ml/kg) and partially filled lung (6 ml/kg), a moderate VT (9 ml/kg) and lung filled to FRC with PFC, and a large VT (15 ml/kg) and partially filled lung (6 ml/kg). PEEP was maintained at 5 cm H2O except in the moderate VT, partial-filling group, in which a PEEP of 9 cm H2O was used to maintain the rabbits for the duration of the experiment. Oxygenation was satisfactory in all groups, and peak inspiratory pressures were not significantly different. However, five of the 13 animals in the large-VT, PFC-filled lung group died of a pneumothorax prior to completion of the experiment. Of the eight animals in this group surviving the experiment, two had radiographic evidence of pneumothoraces, with an additional three animals having autopsy evidence of air leak. Of the 22 animals in the other groups, all survived with the exception of a single rabbit in the large VT, partial-filling group, which had both radiographic and autopsy evidence of air leak. We conclude that there is a significant risk of barotrauma in a PLV strategy in which a large VT is used in association with a lung filled to FRC with perfluorocarbon. Adequate gas exchange can be achieved with alternative ventilation strategies in combination with PLV.
Collapse
Affiliation(s)
- P N Cox
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Some 115 bereaved subjects (43 spouses, 39 adult children, and 33 parents) were followed-up prospectively over 12 months following the acute bereavement period. They completed the Zung Depression Scale, Spielberger's State and Trait Anxiety Measure, the GHQ-28, and Eysenck's Personality Inventory at four time points. With the exception of EPI-Extroversion, there was a significant decrease in all scores over the period encompassing the study. There were no differences between the three groups on any of the psychological variables measured. Scores on the Zung Depression Scale, state and trait anxiety, and neuroticism correlated significantly with a measure of core bereavement phenomenology, the Core Bereavement Items, at each time point for each group.
Collapse
Affiliation(s)
- W Middleton
- Department of Psychiatry, University of Queensland, Australia
| | | | | | | |
Collapse
|
31
|
Kavanagh BP, Ngo C, Raymer K, Yang H, Alhashemi JA, Lui ACP, Reid D, Cicutti N, Krepski B, Wood G, Heyland DK, Badner NH, Murkin JM, Mohr J, McKenzie FN, van der Starre PJA, van Rooyen-Butijn WT, Wilson-Yang K, Teoh K, Lee RMKW, Hossain I, Cheng D, Karski J, Asokumar B, Sandier A, St-Amand MA, Murkin JM, Menkis AH, Downey DB, Nantau W, Adams S, Dowd N, Cheng D, Wong D, Carroll-Munro J, Trachuk C, Cregg N, Cheng DCH, Williams WG, Karski JM, Siu S, Webb G, Cheng DCH, Wong DT, Kustra R, Karski J, Tibshirani RJ, Côté DL, Lacey DE, LeDez KM, Smith JA, Crosby ET, Orkin FK, Fisher A, Volgyesi G, Silverman J, Edelstein S, Rucker J, Sommer L, Dunington S, Roy L, Crochetière C, Arsenault MY, Villeneuve E, Lortie L, Grange CS, Douglas MJ, Adams TJ, Merrick PM, Lucas SB, Morgan PJ, Halpern S, Lo J, Giesinger CL, Halpern SH, Breen TW, Vishnubala S, Shetty GR, De Kock M, Lagmiche A, Scholtes JL, Grodecki W, Duffy PJ, Hull KA, Hawboldt GS, Clark AJ, Smith JB, Norman RW, Beattie WS, Sandier A, Jewett M, Valiquette L, Katz J, Fradet Y, Redelmeier D, Sampson H, Cole J, Chedore T, Snedden W, Green RG, Sosis MB, Robles PI, Lazar ER, Jolly DT, Tarn YK, Tawfik SR, Clanachan AS, Milne A, Beamish T, Cuillerier DJ, Sharpe MD, Lee JK, Basta M, Krahn AD, Klein GJ, Yee R, Vakharia N, Francis H, Scheepers L, Vaghadia H, Carrier J, Martin R, Pirlet M, Claprood Y, Tétrault JP, Wong TD, Ryner L, Kozlowski P, Scarth G, Warrian RK, Lefevre G, Thiessen D, Girling L, Doiron L, McCudden C, Saunders J, Mutch WAC, Duffy PJ, Langevin S, Lessard MR, Trépanier CA, Hare GMT, Ngan JCS, Viskari D, Berrill A, Jodoin C, Couture J, Bellemare F, Farmer S, Muir H, Money P, Milne B, Parlow J, Raymond J, Williams JM, Craen RA, Novick T, Komar W, Frenette L, Cox J, Lockhart B, McArdle P, Eckhoff D, Bynon S, Dobkowski WB, Grant DR, Wall WJ, Chedrawy EG, Hall RI, Nedelcu V, Parlow J, Viale JP, Bégou G, Sagnard P, Hughson R, Quintin L, Troncy É, Collet JP, Shapiro S, Guimond JG, Blair L, Ducruet T, Francœur M, Charbonneau M, Blaise G, Snedden W, Bernadska E, Manson HI, Kutt JL, Mezon BY, Nishida O, Arellano R, Boylen P, DeMajo W, Archer DP, Roth SH, Raman S, Manninen P, Boyle K, Cenic A, Lee TY, Gelb AW, Reinders FX, Brown JIM, Baker AJ, Moulton RJ, Schlichtert L, Schwarz SKW, Puil E, Finegan BA, Finucane BT, Kurrek MM, Devitt JH, Morgan PJ, Cleave-Hogg D, Bradley J, Byrick R, Spadafora SM, Fuller JG, Gelula MH, Mayson K, Forster B, Byrick RJ, McKnight DJ, Kurrek M, Kolton M, Cleave-Hogg D, Haughton J, Halpern S, Kronberg J, Shysh S, Eagle C, Dagnone AJ, Parlow JL, Blaise G, Yang F, Nguyen H, Troncy E, Czaika G, Wachowski I, Basta M, Krahn AD, Yee R, Deladrière H, Cambier C, Pendeville P, Hung OR, Coonan E, Whynot SC, Mezei M, Coonan E, Whynot SC, Ho AMH, Luchsinger IS, Ling E, Mashava D, Chinyanga HM, Cohen MM, Shaw M, Robblee JA, Labow RS, Rubens FD, Diemunsch AM, Gervais R, Rose DK, Cohen MM, O’Brien-Pallas L, Copplestone C, Rose DK, Karkouti K, Sykora K, Cheung SLW, Booker PD, Franks R, Pozzi M, Guard B, Sikich N, Lerman J, Levine M, Swan H, Cox P, Montgomery C, Dunn G, Bourne R, Kinahan A, McCormack J, Dunn GS, Reimer EJ, Sanderson P, Sanderson PM, Montgomery CJ, Betts TA, Orlay GR, Wong DH, Cohen M, Al-Kaisy AA, Chan V, Peng P, Perlas A, Miniad A, Cushing EV, Mills KR, El-Beheiry H, Jahromi SS, Weaver J, Morris M, Carien PL, Cowan RM, Manninen P, Richards J, Robblee JA, Labow RS, Rubens FD, Menkis AH, Adams S, Henderson BT, Hudson RJ, Thomson IR, Moon M, Peterson MD, Rosenbloom M, Davison PJ, Ali M, Ali NS, Searle NR, Thomson I, Roy M, Gagnon L, Lye A, Walsh F, Middleton W, Wong D, Langer A, Errett L, Mazer CD, Karski J, Tibshirani RJ, Williamson KM, Smith G, Gnanendran KP, Bignell SJ, Jones S, Sleigh J, Arnell M, Schultz JAI, Fear DW, Ganapathy S, Moote C, Wassermann R, Watson J, Armstrong K, Calikyan AO, Yilmaz O, Kose Y, Peng P, Chan V, Chung F, Claxton AR, Krishnathas A, Mezei G, Badner NH, Paul TL, Doyle JA, Mehta M, DeLima LGR, Silva LEO, May WL, Maliakkal RJ, Mehta M, Kolesar R, Arellano R, Rafuse S, Fletcher M, Dunn G, Curran M, Bragg P, Chamberlain W, Crossan M, Ganapathy S, Sandhu H, Spadafora S, Mian R, Evans B, Hurst L, Katsiris S. Abstracts. Can J Anaesth 1997. [DOI: 10.1007/bf03022274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
32
|
Abstract
As part of a longitudinal study of bereavement phenomena in three groups, bereaved spouses, bereaved adult children and bereaved parents, scale development was carried out using a pool of bereavement phenomenology questions administered prospectively. The items were derived from the literature, in particular studies dealing with the measurement of grief/bereavement, as well as from clinical experience. Factor analysis of theoretically grouped items produced seven subscales, three of which tapped frequently experienced phenomena in the bereaved. These three subscales formed the basis of a single measure, labelled the Core Bereavement Items (CBI), which demonstrated high reliability and sound face and discriminant validity. Preliminary analysis suggested that the CBI will prove to be a reliable and valid instrument with respect to the measure of core bereavement phenomena in commonly bereaved groups in Western society.
Collapse
Affiliation(s)
- P Burnett
- Queensland University of Technology, Australia
| | | | | | | |
Collapse
|
33
|
Abstract
BACKGROUND Literature and clinical experience suggest that some people experience atypical, complicated or pathological bereavement reactions in response to a major loss. METHOD Three groups of community-based bereaved subjects--spouses (n = 44), adult children (n = 40), and parents (n = 36)--were followed up four times in the 13 months after a loss. A 17-item scale of core bereavement times was developed and used to investigate the intensity of the bereavement response over time. RESULTS Cluster analysis revealed a pattern of bereavement-related symptoms approximating a syndrome of chronic grief in 11 (9.2%) of the 120 subjects. None of the respondents displayed a pattern consistent with delayed or absent grief. CONCLUSIONS In a non-clinical community sample of bereaved people, delayed or absent grief is infrequently seen, unlike chronic grief, which is demonstrated in a minority.
Collapse
Affiliation(s)
- W Middleton
- Department of Psychiatry, University of Queensland, Australia
| | | | | | | |
Collapse
|
34
|
Abstract
If unrealistic optimism is simply a manifestation of the illusion of control (McKenna, 1993), differences in estimates of the likelihood of events for the self and others (comparative optimism) should have concomitant differences in perceived capacity to control these events. This possibility was tested in the domain of health, along with Perloff & Fetzer's (1986) risk-factor version of this downward comparison hypothesis and the hitherto neglected possibility that unrealistic optimism is an artifact of the comparative procedures employed in studies to date. It was found that likelihood judgements for a range of illnesses tended to be significantly lower when made by subjects providing self-ratings than when made by those providing judgements for the 'typical' student and, to a lesser extent, those making judgements for a friend's friend, but not by those doing so for an acquaintance. This comparative optimism was associated with equivalent differences in perceptions of these targets on a selection of relevant risk factors, but not in ratings of their capacity to control these outcomes (for which there was consensus across targets). The data are thus consistent with the risk-factor version of the hypothesis rather than the control version or the artifact explanation. The theoretical implications of these findings are addressed along with their consequences for health promotion.
Collapse
Affiliation(s)
- P Harris
- Division of Psychology, University of Hertfordshire, Hatfield, UK
| | | |
Collapse
|
35
|
Middleton W. Further comments on multiple personality disorder. Aust N Z J Psychiatry 1994; 28:154-6. [PMID: 8067963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
36
|
Burnett P, Middleton W, Raphael B, Dunne M, Moylan A, Martinek N. Concepts of normal bereavement. J Trauma Stress 1994; 7:123-8. [PMID: 8044436 DOI: 10.1007/bf02111918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study used a 25-item questionnaire to examine the perceptions of 128 people with a close interest in bereavement and its literature. The study is part of a project to identify key aspects and the bereavement process. Subjects were asked to rate their perceptions of key bereavement phenomena with regards their frequency in the acute and later stages of bereavement. Descriptive results are presented and discussed, and a profile of phenomena perceived to be common to both stages is outlined.
Collapse
Affiliation(s)
- P Burnett
- School of Learning and Development, QUT: Kelvin Grove Campus, Brisbane, Australia
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
This paper reports on part of a study which was aimed at assessing the views of leading researchers, theorists or clinicians working in the field of bereavement on key issues including, as reported here, concepts of different forms of grief as well as favoured theoretical orientations. Of a range of conceptual models the most favoured, by a large margin, were attachment theory and the psychodynamic model. The views of the "experts" were canvassed with respect to the use of seven selected terms used to denote some variant of the grieving process. There was, on the part of the respondents, reasonable support for the syndromes of "delayed", "chronic", "anticipatory" and "absent" grief. "Inhibited" and "unresolved" grief tended to be described using one of the four terms already supported, while the use of the term "distorted grief" attracted little support.
Collapse
Affiliation(s)
- W Middleton
- Royal Brisbane Hospital, Herston, Queensland
| | | | | | | | | |
Collapse
|
38
|
Ray P, Berman JD, Middleton W, Brendle J. Botulinum toxin inhibits arachidonic acid release associated with acetylcholine release from PC12 cells. J Biol Chem 1993; 268:11057-64. [PMID: 8496167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The molecular mechanisms of depolarization-induced calcium-dependent acetylcholine (ACh) release and its inhibition by botulinum neurotoxin type A (BoTx) are not clear. We studied these mechanisms in an in vitro cholinergic neuronal pheochromocytoma PC12 cell line model. Cultured monolayer PC12 cells were differentiated by treatment with 50 ng/ml nerve growth factor (NGF) for 4 days to enhance cellular ACh synthesis and release. Stimulation of these cells with high K+ (80 mM) in the perfusion medium caused a marked increase (three to four times) in [3H]ACh release in a Ca(2+)-dependent manner. K(+)-stimulated [3H]ACh release was totally inhibited by pretreatment of cells with BoTx (2 nM) for 2 h. High K+ also stimulated the release of arachidonic acid ([3H]AA) from the cell membrane, which was inhibited by BoTx (2 nM). Addition of phospholipase A2 (PLA2) inhibitors (quinacrine, 4-bromophenacyl bromide, manoalide) to the perfusion medium inhibited K(+)-stimulated [3H]ACh and [3H]AA release in a dose-dependent manner. Inclusion of exogenous AA, the PLA2 activator melittin, or PLA2 itself prevented the effect of BoTx. These results demonstrate that in NGF-differentiated PC12 cells, AA release is associated with ACh release, BoTx inhibits both processes, and increased AA can protect against BoTx.
Collapse
Affiliation(s)
- P Ray
- Department of Biology, Walter Reed Army Institute of Research, Washington, D.C. 20067
| | | | | | | |
Collapse
|
39
|
Evans L, Strumpf N, Williams C, Williams T, Middleton W. Perceptions of Physical Restraint: A Comparison between European and American Nursing Home Staff. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_3.p39-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Crompton DR, Pegg SP, Jellett LB, Middleton W. Altered pharmacokinetics of tricyclic antidepressants in burns. Aust N Z J Psychiatry 1991; 25:419-21. [PMID: 1958167 DOI: 10.3109/00048679109062645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of self-inflicted burns which occurred in the setting of a major depression with psychotic features is described. The case emphasises the difficulties in utilising plasma (serum) tricyclic antidepressant levels to determine adequacy of treatment and risk of toxicity. The case discussion demonstrates the altered pharmacokinetics of tricyclic antidepressants that can occur during disorders such as burns, surgery and medical illness.
Collapse
|
41
|
Ray P, Middleton W, Berman JD. Mechanism of agonist-induced down-regulation and subsequent recovery of muscarinic acetylcholine receptors in a clonal neuroblastoma x glioma hybrid cell line. J Neurochem 1989; 52:402-9. [PMID: 2562988 DOI: 10.1111/j.1471-4159.1989.tb09135.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The mechanisms of carbachol-induced muscarinic acetylcholine receptor (mAChR) down-regulation, and recovery following carbachol withdrawal, were studied in the neuroblastoma x glioma hybrid NG108-15 cell line by specific ligand binding assays. N-[3H]Methylscopolamine ([3H]NMS) and [3H]quinuclidinyl benzilate ([3H]QNB) were used as the ligands for the cell surface and total cellular mAChRs, respectively. Exposure of cells to 1 mM carbachol for 16 h decreased the specific binding of [3H]NMS and [3H]QNB by approximately 80%. Bacitracin (1-4 mg/ml) and methylamine (1-15 mM), inhibitors of transglutaminase and of endocytosis, prevented agonist-induced loss of surface mAChRs. Pretreatment of cells with the antimicrotubular agents nocodazole (0.1-10 microM) and colchicine (1-10 microM) prevented carbachol-induced loss of [3H]QNB binding, but not that of [3H]NMS binding. These results indicate that agonist-induced mAChR down-regulation occurs by endocytosis, followed by microtubular transport of receptors to their intracellular degradation sites. When carbachol was withdrawn from the culture medium following treatment of cells for 16 h, receptors recovered and were incorporated to the surface membrane. This recovery process was antagonized by monovalent ionophores monensin (0.1 microM) and nigericin (40 nM), which interfere with Golgi complex function. Receptor recovery was also prevented by the antimicrotubular agent nocodazole. Thus, recovery of receptors appears to be mediated via Golgi complex and microtubular transport to the surface membrane.
Collapse
Affiliation(s)
- P Ray
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Washington, D.C. 20307-5100
| | | | | |
Collapse
|
42
|
Affiliation(s)
- B Raphael
- University of Queensland, Royal Brisbane Hospital, Herston, Australia
| | | |
Collapse
|
43
|
Abstract
Between 1974 and 1983, Australia experienced the Darwin cyclone, the Granville rail disaster, and the Ash Wednesday bush-fires, each of which killed more than 60 people and caused significant emotional distress. Mental health response systems developed in the wake of the disasters varied in their level of sophistication and degree of acceptance, but they generally became better orchestrated and appreciated with each disaster. Lessons learned from research and review following one disaster were often applied in responding to the next. Research and review were particularly crucial in uncovering the presence of significant morbidity, including posttraumatic stress disorder, among relief workers and children and in highlighting the need for coordination of mental health services with other relief efforts. Many jurisdictions in Australia have since modified their disaster relief plans to include mental health services.
Collapse
Affiliation(s)
- B Raphael
- University of Queensland, Department of Psychiatry, Royal Brisbane Hospital, Herston, Australia
| | | |
Collapse
|
44
|
Middleton W, Raphael B. Bereavement. State of the art and state of the science. Psychiatr Clin North Am 1987; 10:329-43. [PMID: 3317311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
For bereavement research to fulfill its potential, its practical applications with defined patient groups needs to demonstrate a superiority over treatment based largely on intuition and common sense. The "art" of the therapist needs science to move beyond the present impasse in the management of bereavement.
Collapse
|
45
|
Raphael B, Middleton W. Whose life and whose death. Qual Assur Util Rev 1987; 2:22-9. [PMID: 2980896 DOI: 10.1177/0885713x8700200106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
46
|
Voegele LD, Rosenblum R, Derrick FC, Carter WC, Prioleau WH, Middleton W, Hairston P. Surgical treatment of renal cell carcinoma extending as a tumor thrombus into the superior vena cava: a case report. J S C Med Assoc 1986; 82:347-9. [PMID: 3458969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
47
|
Flenley DC, Brash H, Clancy L, Cooke NJ, Leitch AG, Middleton W, Wraith PK. Ventilatory response to steady-state exercise in hypoxia in humans. J Appl Physiol Respir Environ Exerc Physiol 1979; 46:438-46. [PMID: 438009 DOI: 10.1152/jappl.1979.46.3.438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
48
|
|
49
|
Flenley D, Clancy L, Leitch A, Middleton W, Wraith P, Brash H. Ventilatory responses to transient and steady state hypoxia during exercise. Chest 1978. [DOI: 10.1378/chest.73.2.283b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
50
|
Leonard N, Sentz R, Middleton W. Rearrangement of alpha-Aminoketones during Clemmensen Reduction. IX. The Fate of Asymmetry at the alpha-Carbon - Correction. J Am Chem Soc 1953. [DOI: 10.1021/ja01120a631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|