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Pediatric Hematologist-Oncologist, Anatomic Pathologist, Allergist & Immunologist
31 years of experience
Accepting new patients
Video profile

Credentials

Education ?

Medical School Score Rankings
University of Minnesota, Twin Cities (1981)
  •  
Top 25%

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Patients' Choice Award (2008 - 2009)
On-Time Doctor Award (2014)
Associations
American Board of Pediatrics

Affiliations ?

Dr. Shapiro is affiliated with 9 hospitals.

Hospital Affiliations

Score

Rankings

  • St Francis Regional Medical Center
    1455 Saint Francis Ave, Shakopee, MN 55379
    •  
    Top 25%
  • Abbott - Northwestern Hospital Inc
    Medical Oncology
    800 E 28th St, Minneapolis, MN 55407
    •  
    Top 50%
  • North Memorial Medical Center
    Medical Oncology
    3300 Oakdale Ave N, Minneapolis, MN 55422
    •  
    Top 50%
  • Children's Hospitals & Clinics
    2525 Chicago Ave, Minneapolis, MN 55404
  • Childrens St. Paul
    345 Smith Ave N, Saint Paul, MN 55102
  • Sister Kenny Rehabilitation Institute
    800 E 28th St, Minneapolis, MN 55407
  • Children's Hospitals and Clinics of Minnesota, Minneapolis
    2525 Chicago Ave, Minneapolis, MN 55404
  • Childrens Hospital Minneapolis
  • North Memorial Medical Center
  • Publications & Research

    Dr. Shapiro has contributed to 163 publications.
    Title Malignancies in the Setting of Primary Immunodeficiency: Implications for Hematologists/oncologists.
    Date February 2011
    Journal American Journal of Hematology
    Excerpt

    Many primary immunodeficiency disorders (PIDD) are associated with elevated risks for different types of cancer. Defective immunosurveillance mechanisms in PIDD and infection with oncogenic viruses (eg, Epstein Barr, herpesvirus 8) seem to have significant contributory roles in many cases. Non-Hodgkin lymphoma and Hodgkin disease are two of the most common PIDD-associated malignancies. The impact of PIDD-associated malignancy has increased in recent years in parallel with improved patient with PIDD survival and longevity, due largely to effective immunoglobulin replacement therapy. Epidemiologic data, clinical patterns, and management considerations of the common PIDD-associated cancers are reviewed.

    Title Integrating Bioethics into Clinical and Translational Science Research: a Roadmap.
    Date October 2010
    Journal Clinical and Translational Science
    Excerpt

    Recent initiatives to improve human health emphasize the need to effectively and appropriately translate new knowledge gleaned from basic biomedical and behavioral research to clinical and community application. To maximize the beneficial impact of scientific advances in clinical practice and community health, and to guard against potential deleterious medical and societal consequences of such advances, incorporation of bioethics at each stage of clinical and translational science research is essential. At the earliest stage, bioethics input is critical to address issues such as whether to limit certain areas of scientific inquiry. Subsequently, bioethics input is important to assure not only that human subjects trials are conducted and reported responsibly, but also that results are incorporated into clinical and community practices in a way that promotes and protects bioethical principles. At the final stage of clinical and translational science research, bioethics helps to identify the need and approach for refining clinical practices when safety or other concerns arise. The framework we present depicts how bioethics interfaces with each stage of clinical and translational science research, and suggests an important research agenda for systematically and comprehensively assuring bioethics input into clinical and translational science initiatives.

    Title Subcutaneous Immunoglobulin: Opportunities and Outlook.
    Date February 2010
    Journal Clinical and Experimental Immunology
    Excerpt

    Immunoglobulin (Ig) administration via the subcutaneous (s.c.) route has become increasingly popular in recent years. The method does not require venous access, is associated with few systemic side effects and has been reported to improve patients' quality of life. One current limitation to its use is the large volumes which need to be administered. Due to the inability of tissue to accept such large volumes, frequent administration at multiple sites is necessary. Most studies conducted to date have investigated the use of subcutaneous immunoglobulin (SCIg) in patients treated previously with the intravenous (i.v.) formulation. New data now support the use of s.c. administration in previously untreated patients with primary immunodeficiencies. SCIg treatment may further be beneficial in the treatment of autoimmune neurological conditions, such as multi-focal motor neuropathy; however, controlled trials directly comparing the s.c. and i.v. routes are still to be performed for this indication. New developments may further improve and facilitate the s.c. administration route. For example, hyaluronidase-facilitated administration increases the bioavailability of SCIg, and may allow for the administration of larger volumes at a single site. Alternatively, more concentrated formulations may reduce the volume required for administration, and a rapid-push technique may allow for shorter administration times. As these developments translate into clinical practice, more physicians and patients may choose the s.c. administration route in the future.

    Title Hsp90 Orchestrates Temperature-dependent Candida Albicans Morphogenesis Via Ras1-pka Signaling.
    Date July 2009
    Journal Current Biology : Cb
    Excerpt

    Hsp90 is an environmentally contingent molecular chaperone that influences the form and function of diverse regulators of cellular signaling. Hsp90 potentiates the evolution of fungal drug resistance by enabling crucial cellular stress responses. Here we demonstrate that in the leading fungal pathogen of humans, Candida albicans, Hsp90 governs cellular circuitry required not only for drug resistance but also for the key morphogenetic transition from yeast to filamentous growth that is crucial for virulence. This transition is normally regulated by environmental cues, such as exposure to serum, that are contingent upon elevated temperature to induce morphogenesis. The basis for this temperature dependence has remained enigmatic.

    Title The Significance Of Infection In Allergic Disease-its Influence on Diagnosis and Management.
    Date August 2008
    Journal California Medicine
    Excerpt

    The presence of infection in allergic disease produces a confused picture in which two different causative factors must be clearly separated by the physician if he is to treat the patient successfully. The effects of infection are not consistent. There are situations, as seen in infectious diseases, where symptoms of allergic disease are temporarily relieved and others where the infection may intensify or precipitate the allergic condition. It is likewise important to recognize the complications superimposed upon allergic disease by infection. In such cases, control of the infection is as dependent upon control of the allergy as it is upon antibiotics.

    Title Future Issues in Transplantation Ethics: Ethical and Legal Controversies in Xenotransplantation, Stem Cell, and Cloning Research.
    Date August 2008
    Journal Transplantation Reviews (orlando, Fla.)
    Excerpt

    With little prospect of developing a sufficient supply of human transplantable organs to meet the large and growing demand, attention has turned to xenotransplantation, as well as stem cell and cloning research, as possible approaches for alleviating this allograft shortage. This article explores ethical and legal issues that surround developments in these fields.

    Title Use of Bladder Pressure to Correct for the Effect of Expiratory Muscle Activity on Central Venous Pressure.
    Date March 2008
    Journal Intensive Care Medicine
    Excerpt

    To assess whether subtracting the expiratory change in intra-abdominal (bladder) pressure (Delta IAP) from central venous pressure (CVP) provides a reliable estimate of transmural CVP in spontaneously breathing patients with expiratory muscle activity.

    Title Hepatic Imaging in the 21st Century.
    Date January 2007
    Journal Seminars in Liver Disease
    Excerpt

    Imaging of the liver has progressed rapidly during the past decade with continued advancement of current ultrasound, computed tomography, and magnetic resonance imaging (MRI). Each modality not only has seen refinement enabling better anatomic characterization of disease but also has received strength from the addition of new techniques to its resources. New contrast agents have become available for all modalities and some agents, particularly for MRI, have opened the way for better functional assessment. MRI continues to see an elaboration of sequences (including spectroscopy and diffusion) that also open imaging to the microscopic structure of disease and normal function. The further development of workstations have improved both analysis and depiction of disease. In the 21st century imaging will continue to shift from a simple source of anatomic information to a more functional problem-solving tool.

    Title The Fda and Drug Safety: a Proposal for Sweeping Changes.
    Date November 2006
    Journal Archives of Internal Medicine
    Excerpt

    The current Food and Drug Administration (FDA) system of regulating drug safety has serious limitations and is in need of changes. The major problems include the following: the design of initial preapproval studies lets uncommon, serious adverse events go undetected; massive underreporting of adverse events to the FDA postmarketing surveillance system reduces the ability to quantify risk accurately; manufacturers do not fulfill the majority of their postmarketing safety study commitments; the FDA lacks authority to pursue sponsors who violate regulations and ignore postmarketing safety study commitments; the public increasingly perceives the FDA as having become too close to the regulated pharmaceutical industry; the FDA's safety oversight structure is suboptimal; and the FDA's expertise and resources in drug safety and public health are limited. To address these problems, we urge Congress, which is ultimately responsible for the FDA's performance, to implement the following 5 recommendations: (1) give the FDA more direct legal authority to pursue violations, (2) authorize the adoption of a conditional drug approval policy, at least for selected drugs, (3) provide additional financial resources to support the safety operations, (4) mandate a reorganization of the agency with emphasis on strengthening the evaluation and proactive monitoring of drug safety, and (5) require broader representation of safety experts on the FDA's advisory committees.

    Title Drosophila Ik2, a Member of the I Kappa B Kinase Family, is Required for Mrna Localization During Oogenesis.
    Date June 2006
    Journal Development (cambridge, England)
    Excerpt

    In both Drosophila and mammals, IkappaB kinases (IKKs) regulate the activity of Rel/NF-kappaB transcription factors by targeting their inhibitory partner proteins, IkappaBs, for degradation. We identified mutations in ik2, the gene that encodes one of two Drosophila IKKs, and found that the gene is essential for viability. During oogenesis, ik2 is required in an NF-kappaB-independent process that is essential for the localization of oskar and gurken mRNAs; as a result, females that lack ik2 in the germline produce embryos that are both bicaudal and ventralized. The abnormal RNA localization in ik2 mutant oocytes can be attributed to defects in the organization of microtubule minus-ends. In addition, both mutant oocytes and mutant escaper adults have abnormalities in the organization of the actin cytoskeleton. These data suggest that this IkappaB kinase has an NF-kappaB-independent role in mRNA localization and helps to link microtubule minus-ends to the oocyte cortex, a novel function of the IKK family.

    Title Management of Thyroid Nodules Detected at Sonography: Society of Radiologists in Ultrasound Consensus Conference Statement.
    Date June 2006
    Journal Thyroid : Official Journal of the American Thyroid Association
    Title Diagnostic Value of Tissue Harmonic Imaging Compared with Conventional Sonography.
    Date January 2006
    Journal Computers in Biology and Medicine
    Excerpt

    The purpose of this study was to determine if tissue harmonic imaging (THI) produced diagnostic images more frequently than conventional sonography. A prospective study was performed on 33 patients, to compare the diagnostic value of THI with conventional sonography. Each examination was performed using THI (transmit frequency=2.0 MHz, receive frequency=4.0 MHz) and conventional sonography at 2.5 and 4.0 MHz. The different sonographic techniques were then graded as to whether they produced diagnostic images. THI produced diagnostic images in 33 of 33 examinations (100%), 2.5 MHz conventional sonography produced diagnostic images in 26 of 33 examinations (79%), and 4.0 MHz conventional sonography produced diagnostic images in 26 of 33 examinations (79%). THI produced diagnostic images significantly more frequently than 2.5 MHz conventional sonography (p=.0233) and 4.0 MHz conventional sonography (p=.0233). The THI technique produced diagnostic images more frequently than conventional sonography.

    Title Recognition of Fossil Prokaryotes in Cretaceous Methane Seep Carbonates: Relevance to Astrobiology.
    Date April 2005
    Journal Astrobiology
    Excerpt

    Recovery of prokaryotic body fossils from methane seep carbonates such as those of the Cretaceous Tepee Buttes of Colorado serves as a model for sampling in future astrobiological missions. The fossils, found primarily at the interface between paragenetic fabrics, suggest a sharp physicochemical gradient. Evidence of these microbial fossils occurs at a variety of scales. In the field, microbialite is found as meter-scale thrombolitic zones and centimeterscale stromatolitic crusts lining voids inferred to be the sites of ancient methane seepage. Petrographic fabrics suggestive of microbialite include indistinct peloids (0.1-1 mm in diameter) and crusts of authigenic micrite. Primary evidence obtained from scanning electron microscopy coupled with energy-dispersive x-ray spectroscopy analysis comprises pinnate bacteria (0.3 microm in diameter and 1-1.5 microm long), sheaths (2-4 microm in diameter), coccoids (0.5-1 microm in diameter, up to 40 per cluster), and the presence of framboidal pyrite (6-8 microm in diameter). These results are in agreement with studies of other ancient and modern seeps and suggest a morphological conservatism of microbial form that can be incorporated into studies of extraterrestrial environments where it is presumed that reduced gases drive the metabolic activity of prokaryote-like organisms. Target areas that could serve as conduits for reduced gas seeps include tectonic or impact-driven faulting, zones of cryosphere melting, or other disruptions in crustal coherence. Ancient seeps, preserved as localized anomalous evaporite deposits in the sedimentary cover, could be detected by remote sensing.

    Title Cryotherapy and Percutaneous Ablation.
    Date August 2004
    Journal Ajr. American Journal of Roentgenology
    Title Effect of Prolongation of Expiratory Time on Dynamic Hyperinflation in Mechanically Ventilated Patients with Severe Asthma.
    Date August 2004
    Journal Critical Care Medicine
    Excerpt

    To assess the effect of a decrease in respiratory rate on dynamic hyperinflation, as determined by changes in plateau airway pressure, in patients with status asthmaticus whose baseline minute ventilation approximated 10 L/min.

    Title Legislative Research Bans on Human Cloning.
    Date March 2004
    Journal Cambridge Quarterly of Healthcare Ethics : Cq : the International Journal of Healthcare Ethics Committees
    Title Managed Care, Doctors, and Patients: Focusing on Relationships, Not Rights.
    Date November 2003
    Journal Cambridge Quarterly of Healthcare Ethics : Cq : the International Journal of Healthcare Ethics Committees
    Title Panoramic Ultrasound of the Thyroid.
    Date October 2003
    Journal Thyroid : Official Journal of the American Thyroid Association
    Excerpt

    Panoramic ultrasound is a technical modification of conventional ultrasound that produces images with a large anatomic field of view. Images obtained with this technique display both lobes of the thyroid gland on a single image, and provide an accurate imaging representation of a variety of thyroid disorders. This report describes the use of panoramic ultrasound and presents examples of panoramic ultrasound of the thyroid.

    Title A Pilot Project to Study the Use of Ultrasonography for Teaching Physical Examination to Medical Students.
    Date April 2003
    Journal Computers in Biology and Medicine
    Excerpt

    The purpose of this study was to study the use of ultrasound as an aid to teaching physical examination. Five medical students were given a 1-week course in ultrasound, and were then assigned to clinical rotations to perform ultrasound and physical examinations on patients. Basic ultrasound skills were assessed by having each student scan the same normal model at the conclusion of the first week and at the conclusion of the project. Clinical cases were presented to a preceptor, and the ultrasound images were graded on a five-point scale. At the end of the first week, the mean grade of ultrasound examinations performed on the control model was 3.2, improving to 4.4 at the end of the project. Grading of ultrasound exams performed during the first clinical week averaged 4.1, improving to 4.5 at the end of the project. An exit survey indicated a favorable response to using ultrasound as an educational tool.

    Title Overestimation of Pulmonary Artery Occlusion Pressure in Pulmonary Hypertension Due to Partial Occlusion.
    Date February 2003
    Journal Critical Care Medicine
    Excerpt

    To evaluate partial occlusion in patients with pulmonary hypertension with regard to a) the degree to which it leads to overestimation of pulmonary artery occlusion pressure (Ppao) and b) identification of factors that could enhance its recognition.

    Title Microcystic Features at Us: a Nonspecific Sign for Microcystic Adenomas of the Pancreas.
    Date July 2002
    Journal Radiographics : a Review Publication of the Radiological Society of North America, Inc
    Excerpt

    Microcystic adenoma of the pancreas is a benign tumor with no malignant potential and may not require surgery if it is asymptomatic. In the past, a mass containing more than six small (<2-cm) cysts at ultrasonography (US) has been considered to be diagnostic for microcystic adenoma. However, a retrospective study of 36 patients with focal or diffuse pancreatic lesions containing over six small cysts demonstrated that this finding can occur in a wide variety of neoplastic and inflammatory lesions, most of which are malignant. These lesions included adenocarcinoma (n = 18), mucinous cystadenocarcinoma (n = 2), islet cell carcinoma (n = 1), lymphoma (n = 1), sarcoma (n = 1), metastases (n = 2), pancreatitis (n = 4), and adenoma (n = 7). Thus, a finding of multiple small cysts in a pancreatic mass is not specific for microcystic adenoma, and if diagnosis is based on US findings alone, many malignant tumors will be misdiagnosed as microcystic adenomas. Furthermore, computed tomography provides only limited assistance in this setting due to overlapping findings. Needle biopsy can be highly accurate in diagnosing both microcystic adenoma and other malignant lesions and should generally be performed for all lesions with the US features described earlier.

    Title Compound Spatial Sonography of the Thyroid Gland: Evaluation of Freedom from Artifacts and of Nodule Conspicuity.
    Date December 2001
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    The purpose of this study was to compare compound spatial sonography with conventional sonography of the thyroid gland with respect to freedom from sonographic artifacts and conspicuity of thyroid nodules.

    Title Use of Intraoperative Doppler Ultrasound to Diagnose Hepatic Venous Obstruction in a Right Lobe Living Donor Liver Transplant.
    Date September 2001
    Journal Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
    Excerpt

    Right lobe liver transplantation is a relatively new and technically challenging method of living donor transplantation. Integrity of the hepatic venous anastomosis is crucial for successful transplantation. We describe the use of intraoperative Doppler sonography to diagnose stenosis of the hepatic vein anastomosis, with associated compromise of venous drainage and graft perfusion.

    Title Should Hecs Conduct Retrospective Review of Cases from Their Institution for Educational Purposes? No.
    Date September 2001
    Journal Hec Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
    Title Ethical Issues Surrounding Adult-to-adult Living Donor Liver Transplantation.
    Date December 2000
    Journal Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
    Excerpt

    1. The ethical principle of utility is enhanced by living donor liver transplantation (LDLT). LDLT carries the potential to optimize efficient use of organs, minimize pretransplant morbidity and mortality, and increase availability of cadaveric organs. 2. The most serious ethical concerns in LDLT focus on the risks to the donor and relate to the principle of nonmaleficence-"do no harm". Although exact risk remains uncertain, there is potential for significant donor morbidity and even mortality. 3. Careful consideration must be given to development of the best approach to obtaining truly informed consent. 4. Specific criteria for LDLT should be developed for transplant centers, donors, and recipients. Informed consent should be standardized. 5. A national registry for donors and recipients of LDLT is needed.

    Title Microbialite Morphostratigraphy As a Tool for Correlating Late Cambrian-early Ordovician Sequences.
    Date November 2000
    Journal The Journal of Geology
    Excerpt

    Microbialite morphostratigraphy is a new tool for intrabasinal correlation using diverse microbialite structures (morphotypes). The recognition of the succession of morphotypes over constrained temporal intervals and broad areas is a function of the complex interactions that operate to create the structure. Because so many nonlinked variables (e.g., biotic, sedimentological, physicochemical) are involved, similar morphotypes do not reoccur over long temporal intervals. To demonstrate the technique, the upper Cambrian-lowermost Ordovician shelf strata of the Great Basin, United States, were correlated using both morphostratigraphy and standard lithostratigraphy. Six morphozones and one morphosubzone were recognized, as were four main lithologic successions. Because the boundaries between the morphozones and lithologic successions did not coincide, it is inferred that the characteristics of the various microbialite structures are not solely controlled by physical factors. The principles for establishing a morphostratigraphy outlined in this article allow for the potential to correlate along other ancient marine margins in both the same Cambrian and Ordovician interval, as well as any interval in the Phanerozoic in which diverse microbialite structures occur.

    Title Recruitment Maneuvers in Three Experimental Models of Acute Lung Injury. Effect on Lung Volume and Gas Exchange.
    Date June 2000
    Journal American Journal of Respiratory and Critical Care Medicine
    Excerpt

    Recruitment maneuvers (RM), consisting of sustained inflations at high airway pressures, have been advocated as an adjunct to mechanical ventilation in acute respiratory distress syndrome (ARDS). We studied the effect of baseline ventilatory strategy and RM on end-expiratory lung volume (EELV) and oxygenation in 18 dogs, using three models of acute lung injury (ALI; n = 6 in each group): saline lavage (LAV), oleic acid injury (OAI), and intratracheal instillation of Escherichia coli (pneumonia; PNM). All three models exhibited similar degrees of lung injury. The PNM model was less responsive to positive end-expiratory pressure (PEEP) than was the LAV or OAI model. Only the LAV model showed an oxygenation response to increasing tidal volume (VT). After RM, there were transient increases in Pa(O(2)) and EELV when ventilating with PEEP = 10 cm H(2)O. At PEEP = 20 cm H(2)O the lungs were probably fully recruited, since the plateau airway pressures were relatively high ( approximately 45 cm H(2)O) and the oxygenation was similar to preinjury values, thus making the system unresponsive to RM. Sustained improvement in oxygenation after RM was seen in the LAV model when ventilating with PEEP = 10 cm H(2)O and VT = 15 ml/kg. Changes in EELV correlated with changes in Pa(O(2)) only in the OAI model with PEEP = 10 cm H(2)O. We conclude that responses to PEEP, VT, and RM differ among these models of ALI. RM may have a role in some patients with ARDS who are ventilated with low PEEP and low VT.

    Title Managed Care: Effects on the Physician-patient Relationship.
    Date May 2000
    Journal Cambridge Quarterly of Healthcare Ethics : Cq : the International Journal of Healthcare Ethics Committees
    Title Prone Positioning Attenuates and Redistributes Ventilator-induced Lung Injury in Dogs.
    Date March 2000
    Journal Critical Care Medicine
    Excerpt

    BACKGROUND: We previously demonstrated a markedly dependent distribution of ventilator-induced lung injury in oleic acid-injured supine animals ventilated with large tidal volumes and positive end-expiratory pressure > or =10 cm H2O. Because pleural pressure distributes more uniformly in the prone position, we hypothesized that the extent of injury induced by purely mechanical forces applied to the lungs of normal animals might improve and that the distribution of injury might be altered with prone positioning. OBJECTIVE: To compare the extent and distribution of histologic changes and edema resulting from identical patterns of high end-inspiratory/low end-expiratory airway pressures in both supine and prone normal dogs. DESIGN/SETTING: We ventilated 10 normal dogs (5 prone, 5 supine) for 6 hrs with identical ventilatory patterns (a tidal volume that generated a peak transpulmonary pressure of 35 cm H2O when implemented in the supine position before randomization, positive end-expiratory pressure = 3 cm H2O). Ventilator-induced lung injury was assessed by gravimetric analysis and histologic grading. MEASUREMENTS AND MAIN RESULTS: Wet weight/dry weight ratios (WW/DW) and histologic scores were greater in the supine than the prone group (8.8+/-2.8 vs. 6.1+/-0.7; p = .01 and 1.4+/-0.3 vs. 1+/-0.3; p = .037, respectively). In the supine group, WW/DW and histologic scores were significantly greater in dependent than nondependent regions (9.4+/-1.9 vs. 6.7+/-0.9; p = .01 and 2.0+/-0.4 vs. 0.9+/-0.4; p = .043, respectively). In the prone group, WW/DW also was greater in dependent regions (6.7+/-1.1 vs. 5.8+/-0.5; p = .054), but no significant differences were found in histologic scores between dependent and nondependent regions (p = .42). CONCLUSION: In this model of lung injury induced solely by mechanical forces, the prone position resulted in a less severe and more homogeneous distribution of ventilator-induced lung injury. These results parallel those previously obtained in oleic acid-preinjured animals ventilated with higher positive end-expiratory pressure.

    Title Lemierre Syndrome in an Immunocompromised Patient.
    Date January 2000
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Lemierre syndrome or septic thrombophlebitis of the internal jugular vein is a potentially life-threatening complication. This condition may result from oropharyngeal infection, central venous catheterization, and intravenous drug abuse. Immunocompromised patients and individuals with systemic disease are at higher risk of developing the syndrome. We present here a case of septic jugular vein thrombosis in an adolescent with systemic lupus erythematosus. The etiological factors, pathogenesis, and diagnostic and therapeutic measures are discussed.

    Title Small Cis-acting Sequences That Specify Secondary Structures in a Chloroplast Mrna Are Essential for Rna Stability and Translation.
    Date January 2000
    Journal Molecular and Cellular Biology
    Excerpt

    Nucleus-encoded proteins interact with cis-acting elements in chloroplast transcripts to promote RNA stability and translation. We have analyzed the structure and function of three such elements within the Chlamydomonas petD 5' untranslated region; petD encodes subunit IV of the cytochrome b(6)/f complex. These elements were delineated by linker-scanning mutagenesis, and RNA secondary structures were investigated by mapping nuclease-sensitive sites in vitro and by in vivo dimethyl sulfate RNA modification. Element I spans a maximum of 8 nucleotides (nt) at the 5' end of the mRNA; it is essential for RNA stability and plays a role in translation. This element appears to form a small stem-loop that may interact with a previously described nucleus-encoded factor to block 5'-->3' exoribonucleolytic degradation. Elements II and III, located in the center and near the 3' end of the 5' untranslated region, respectively, are essential for translation, but mutations in these elements do not affect mRNA stability. Element II is a maximum of 16 nt in length, does not form an obvious secondary structure, and appears to bind proteins that protect it from dimethyl sulfate modification. Element III spans a maximum of 14 nt and appears to form a stem-loop in vivo, based on dimethyl sulfate modification and the sequences of intragenic suppressors of element III mutations. Furthermore, mutations in element II result in changes in the RNA structure near element III, consistent with a long-range interaction that may promote translation.

    Title Taking Ethics to the Unit-base.
    Date November 1999
    Journal Aspen's Advisor for Nurse Executives
    Title Hepatic Artery Thrombosis: Power Doppler Sonographic Demonstration of Intraarterial Thrombus.
    Date September 1999
    Journal Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    Title In Re Edna Mf: Case Law Confusion in Surrogate Decision Making.
    Date August 1999
    Journal Theoretical Medicine and Bioethics
    Excerpt

    I review the recent case of Edna Folz, a 73 year-old woman who was suffering through the end stages of very advanced Alzheimer's dementia when her case was adjudicated by the Wisconsin Supreme Court. I consider this case as an example of how courts are increasingly misinterpreting the ethical and legal decision-making-standards known as "substituted judgment" and "best interests" and thereby threatening individuals' treatment decision-making rights as developed by other courts over the past two decades and creating serious roadblocks to health-care providers' ability to render appropriate patient care. The Wisconsin Supreme Court held that Edna's legal guardian could not authorize withdrawal of Edna's treatment, ruling that as a matter of law, if an incompetent person is not in a persistent vegetative state, it is not in his or her best interests for life-sustaining treatment to be withdrawn unless (s)he has executed an advance directive or other statement clearly indicating his or her desires.

    Title Massive Pneumatosis Intestinalis: Ct Diagnosis.
    Date August 1999
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    Pneumatosis cystoides intestinalis is a rare condition characterized by multiple subserosal or submucosal gas filled cysts within the wall of a segment of bowel. It is associated with numerous conditions, both intra and extraabdominal in nature. The condition may be asymptomatic or may present clinically as nausea, vomiting, diarrhea or other signs of intestinal obstruction. With rupture of the cysts, pneumoperitoneum may be a finding. In a patient with vague clinical presentation, this finding radiographically may lead to a clinical dilemma as many of these patients have comorbid conditions which are also associated with intestinal perforation. The authors present the case of a 47-year-old obese black female found to have massive pneumatosis intestinalis of the tranverse colon with a small amount of free intraperitoneal air. This case highlights the importance of recognizing pneumatosis intestinalis as a possible mimic of free intraabdominal air as well as a possible cause of benign pneumoperitoneum.

    Title B Cell Lymphoproliferative Disorders Following Hematopoietic Stem Cell Transplantation: Risk Factors, Treatment and Outcome.
    Date May 1999
    Journal Bone Marrow Transplantation
    Excerpt

    Twenty-six cases of B cell lymphoproliferative disorder (BLPD) were identified among 2395 patients following hematopoietic stem cell transplants (HSCT) for which an overall incidence of BLPD was 1.2%. The true incidence was probably higher, since 9/26 of the diagnoses were made at autopsy. No BLPD was observed following autologous HSCT, so risk factor analyses were confined to the 1542 allogeneic HSCT. Factors assessed were HLA-mismatching (> or = 1 antigen), T cell depletion (TCD), presence of acute GvHD (grades II-IV), donor type (related vs unrelated), age of recipient and donor, and underlying disease. Factors found to be statistically significant included patients transplanted for immune deficiency and CML, donor age > or = 18 years, TCD, and HLA-mismatching, with recipients of combined TCD and HLA-mismatched grafts having the highest incidence. Factors found to be statistically significant in a multiple regression analysis were TCD, donor age and immune deficiency, although 7/8 of the patients with immunodeficiencies and BLPD received a TCD graft from a haploidentical parent. The overall mortality was 92% (24/26). One patient had a spontaneous remission, but subsequently died >1 year later of chronic GVHD. Thirteen patients received therapy for BLPD. Three patients received lymphocyte infusions without response. The only patients with responses and longterm survival received alpha interferon (alphaIFN). Of seven patients treated with alphaIFN there were four responses (one partial and three complete). These data demonstrate that alphaIFN can be an effective agent against BLPD following HSCT, if a timely diagnosis is made.

    Title The Role of Tacrolimus in Adult Kidney Transplantation: a Review.
    Date February 1999
    Journal Clinical Transplantation
    Excerpt

    The use of tacrolimus (FK506) in adult kidney-transplant recipients has been the subject of a number of single- and multi-center studies. This review article focuses on those studies in which tacrolimus was used either as rescue therapy in patients who developed refractory rejection on cyclosporine (CyA)-based regimens or as primary immunosuppression in adult renal-allograft recipients. Twenty-five prospective and retrospective studies conducted in the US, Japan and Europe, including single- and multi-center experiences, were identified in the medical literature. Of these studies, most show a 74-98% initial success rate for tacrolimus rescue therapy. Comparative studies reviewed herein demonstrate comparable patient- and graft-survival rates between tacrolimus- and CyA-treated patients. Many studies have shown that rejection episodes occur with similar or lower frequency among patients treated with tacrolimus than among those given CyA as primary immunosuppression. The major toxicities associated with tacrolimus are nephrotoxicity, neurotoxicity and diabetogenicity. Results from several studies have also demonstrated an association between these tacrolimus side effects and high whole-blood trough levels of tacrolimus. In many cases, a reduction in dosage can reverse these adverse effects. In summary, based on both single- and multi-center data, tacrolimus has been demonstrated to be efficacious when used for either primary immunosuppression or as rescue therapy for refractory acute rejection in adult renal-allograft recipients.

    Title Color Doppler Applications in Hepatic Imaging.
    Date December 1998
    Journal Clinical Imaging
    Excerpt

    Color Doppler sonography is an important modality in the non-invasive evaluation of the liver. It is commonly used to evaluate vascular changes which accompany cirrhosis. Doppler techniques are also used to evaluate patients who have undergone liver transplantation or transjugular intrahepatic portosystemic shunt (TIPS) placement. This review describes the various applications of color Doppler in hepatic imaging.

    Title Portal Vein Velocities Measured by Ultrasound: Usefulness for Evaluating Shunt Functioning Following Tips Placement and Tips Revision.
    Date November 1998
    Journal Abdominal Imaging
    Excerpt

    BACKGROUND: To assess the usefulness of following portal vein velocities by Doppler ultrasound in evaluating shunt functioning after transhepatic intrajugular portosystemic shunt (TIPS) placement and revision. METHODS: We retrospectively analyzed 39 patients who underwent a TIPS procedure in the preceding 4 years. Portal vein (PV) velocities were measured by Doppler ultrasound before and after TIPS insertion and revision and were correlated with portosystemic gradients (PSG) measured at angiography. RESULTS: Mean PV velocities increased from 18 +/- 6 cm/s before TIPS placement to 50 +/- 21 cm/s (p < 0.001) after TIPS placement, with corresponding decrease of mean PSG from 20 +/- 6 to 8 +/- 3 mmHg (p < 0.001). Mean PV velocities significantly increased from 24 +/- 6 to 43 +/- 14 cm/s after TIPS revision (p < 0.02), with decrease of PSG from 17 +/- 6 to 9 +/- 5 mmHg (p < 0.05). A significant correlation was found between all PV velocities and their corresponding PSG (Spearman r < 0.61, p < 0.001). CONCLUSION: PV velocities significantly correlate with changes in PSG. Following portal vein velocities by ultrasound is useful for early evaluation of shunt functioning following TIPS.

    Title Tissue Harmonic Imaging Sonography: Evaluation of Image Quality Compared with Conventional Sonography.
    Date November 1998
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE: The purpose of this study was to determine if tissue harmonic imaging (THI) sonography produced higher quality images than did conventional sonography. SUBJECTS AND METHODS: A prospective study was performed on 89 patients to compare the image quality of THI sonography with that of conventional sonography. Each examination was performed using THI sonography (transmitted frequency, 2.0 MHz; received frequency, 4.0 MHz) and conventional sonography at 2.5 and 4.0 MHz. The pancreatic area was studied in 60 patients, and other anatomic areas were studied in 68 patients. The images were then graded for penetration, detail, and total image quality. Graders were unaware of the sonographic technique. RESULTS: Of the 60 pancreatic examinations, THI sonography was the best technique for penetration in 45, detail in 54, and total image quality in 50. For the pancreas, THI sonography was significantly better than 2.5-MHz conventional sonography for penetration (p = .0002), detail (p < .0001), and total image quality (p < .0001). THI sonography was significantly better than 4.0-MHz conventional sonography for penetration (p < .0001), detail (p < .0001), and total image quality (p < .0001). Of the 68 examinations of other anatomic areas, THI sonography was the best technique for penetration in 42, detail in 57, and total image quality in 58. For other anatomic areas, THI sonography was significantly better than 2.5-MHz conventional sonography for penetration (p = .05), detail (p < .0001), and total image quality (p < .0001). THI sonography was significantly better than 4.0-MHz conventional sonography for penetration (p < .0001), detail (p < .0001), and total image quality (p < .0001). CONCLUSION: The THI technique improved sonographic image quality.

    Title Torsion of the Fallopian Tube: Progression of Sonographic Features.
    Date November 1998
    Journal Journal of Clinical Ultrasound : Jcu
    Excerpt

    Isolated torsion of the fallopian tube is a rare gynecologic condition that is difficult to diagnose preoperatively. We present the sonographic and CT findings over a 48-hour period in a case of isolated torsion of the fallopian tube. The radiologic features of isolated torsion have been described previously; however, to our knowledge, the progressive findings have not been previously reported.

    Title Underassessment of Lower Extremity Deep Venous Thrombosis Using Color Flow Doppler Compared to Compression Sonography.
    Date October 1998
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    The aim of this paper is to compare the accuracy of color Doppler to compression sonography in the diagnosis of lower extremity deep vein thrombosis. Longitudinal color flow imaging was performed in 60 lower extremities in patients with clinically suspected deep venous thrombosis (DVT). The study was then repeated by a blinded examiner using transverse compression sonography. The results were then correlated. Thirty-five examinations were negative by both color flow and compression methods. Twenty thrombi were diagnosed on compression sonography, while only 13 were diagnosed by the color flow method. Thirty-five percent of thrombi were missed using color flow imaging alone. We conclude that compression sonography should remain an integral part of the assessment of lower extremity DVT, as a significant number of thrombi might be overlooked using longitudinal color flow imaging alone. This is especially true in non-occlusive thrombi that are adherent to the vessel wall.

    Title Liver Transplant Rejection: Value of Hepatic Vein Doppler Waveform Analysis.
    Date September 1998
    Journal Abdominal Imaging
    Excerpt

    BACKGROUND: To determine whether abnormal hepatic vein Doppler tracings can be used to predict liver transplantation rejection. METHODS: A total of 158 hepatic vein Doppler tracings were obtained on 93 postliver transplant patients (63 patients without rejection and 30 patients with biopsy-proven rejection). Hepatic vein Doppler tracings were scored according to an established grading system (0 = normal triphasic waveform, 1 = dampened waveform, with loss of flow reversal, 2 = completely flat waveform). The hepatic vein Doppler tracings were then correlated with biopsy findings. RESULTS: In the group of 63 patients without rejection, 124 Doppler examinations were performed and graded as follows: 0 = 87 (70%), 1 = 31 (25%), and 2 = 6 (5%). In the group of 30 patients with biopsy-proven rejection, 34 Doppler examinations were performed and graded as follows: 0 = 16 (47%), 1 = 14 (41%), and 2 = 4 (12%). The sensitivity of abnormal hepatic vein Doppler tracings for detection of rejection was 53% and the specificity was 70%. The positive predictive value of an abnormal hepatic vein Doppler tracing was 33% and the negative predictive value of a normal Doppler tracing was 84%. CONCLUSIONS: Abnormal hepatic vein Doppler tracings are observed in patients with and without liver transplant rejection. Abnormal tracings cannot be used to predict liver transplant rejection.

    Title Cryotherapy of Metastatic Carcinoid Tumors.
    Date June 1998
    Journal Abdominal Imaging
    Excerpt

    Background: To describe the use of hepatic cryotherapy to treat patients with symptomatic carcinoid metastates.Methods: Hepatic cryotherapy was performed on five patients with carcinoid syndrome resulting from metastatic carcinoid tumors. Intraoperative ultrasound was used to guide the cryotherapy and to assess the adequacy of freezing.Results: All five patients had relief of the carcinoid syndrome after treatment. In four of the five patients, the relief was prolonged (>3 months); in one patient, the relief of symptoms was transient (2 months). Four of five patients had a transient reduction in hormonal tumor markers (the fifth patient did not have hormonal-level follow-up). During a follow-up period of 2.5 years, four of the five patients died. The 6-month survival rate was 80%, the 1-year survival rate was 60%, the 2-year survival rate was 40%, and the 2.5-year survival was 20%. One patient is alive 30 months after treatment.Conclusion: Hepatic cryotherapy can provide symptomatic relief for patients with hepatic metastates producing the carcinoid syndrome.

    Title Mri Findings in Adenosquamous Carcinoma of the Gallbladder.
    Date May 1998
    Journal Clinical Imaging
    Excerpt

    In this report, we present the MRI findings of adenosquamous carcinoma of the gallbladder, a rare type of gallbladder malignancy. MRI examination not only helped established the diagnosis but also accurately depicted the extent of involvement of the adjacent liver. The ability to image in multiple planes was also useful in assessing the anatomic location of the tumor and in determining that the patient could be treated with surgical resection.

    Title Splenorenal Shunt Closure After Liver Transplantation: Intraoperative Doppler Assessment of Portal Hemodynamics.
    Date January 1998
    Journal Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
    Title Wisconsin Healthcare Ethics Committees.
    Date September 1997
    Journal Cambridge Quarterly of Healthcare Ethics : Cq : the International Journal of Healthcare Ethics Committees
    Title Mri of the Liver. A Pictorial Essay.
    Date August 1997
    Journal Clinical Imaging
    Excerpt

    Magnetic resonance imaging (MRI) is an extremely useful modality for evaluation of the complex pathophysiology of the liver. The high degree of soft tissue contrast afforded by MRI accurately detects and characterizes both focal and diffuse abnormalities of the liver. In this article we present a pictorial review of MRI of the liver.

    Title Successful Correction of Hemophagocytic Lymphohistiocytosis with Related or Unrelated Bone Marrow Transplantation.
    Date June 1997
    Journal Blood
    Excerpt

    Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder of immune regulation leading to widespread lymphocytic and hemophagocytic infiltration of vital organs. Apparent cure has only been achieved with allogeneic bone marrow transplantation (BMT). This report describes 20 consecutive patients, who underwent either matched sibling donor (n = 4) or unrelated donor (URD; n = 16) BMT. Age at the time of BMT was 0.4 to 5.3 years (median, 0.8 years). Central nervous system disease was present at diagnosis in 13 patients. At BMT, 14 patients were in a clinical remission, whereas 6 patients had active HLH. All patients were engrafted after cytoreduction with busulfan, cyclophosphamide, and etoposide. The probability of grade II-III acute graft-versus-host disease (GVHD) for all patients was 57% (95% confidence limit [CL], 0.28, 0.86), and 73% (95% CL, 0.44, 1.0) in URD patients. The overall probability of survival at 3 years was 45% (95% CL, 0.23, 0.67) and 44% (95% CL, 0.19, 0.68) when URD BMT was evaluated separately. Favorable BMT outcome was associated with clinical remission status at the time of BMT. The preparative regimen was well tolerated, and in the 9 surviving patients it provided durable engraftment and was effective at eradicating the underlying disease.

    Title Health Care Providers' Liability Exposure for Inappropriate Pain Management.
    Date June 1997
    Journal The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics
    Title Ct Diagnosis of Acquired Intercostal Lung Herniation.
    Date June 1997
    Journal Clinical Imaging
    Excerpt

    Intercostal lung herniation is a rare complication of trauma, best demonstrated by computed tomography. Most intercostal lung herniations are the result of direct trauma to the chest wall or occur at sites of prior percutaneously placed chest tubes. We present two cases of acquired intercostal lung herniation.

    Title Ablative Adenoidectomy: a New Technique Using Simultaneous Liquefaction/aspiration.
    Date May 1997
    Journal The Journal of Otolaryngology
    Excerpt

    OBJECTIVE: This study was performed to critically evaluate a new cautery technique for adenoidectomy that combines indirect visualization with complete hemostasis, ultimately permitting the surgeon to tailor the procedure to the patient's specific needs. DESIGN: This prospective study of 138 consecutive adenoidectomy patients of the senior author was carried out at the Montreal Children's Hospital over 17 months. Concurrent adenoidectomy patients of another senior otolaryngologist in our institution as well as cases of the senior author using the conventional cold curettage technique served as controls. METHOD: Data were collected preoperatively with respect to indication for surgery and radiologic findings. Operative findings including duration of surgery, concurrent procedures, position of adenoid hypertrophy, and blood loss were also recorded. Postoperative complications such as hemorrhage, infection, dehydration, as well as the incidence of velopharyngeal insufficiency and nasopharyngeal stenosis were also recorded up to 1 year from the date of surgery. The operative technique involves indirect visualization of the nasopharynx with a laryngeal mirror combined with cautery-liquefaction and suction ablation of the adenoid tissue. RESULTS: Our results demonstrate a significant reduction in blood loss as well as a reduction in operative time. There was a low incidence of postoperative infection, no patients required a return to the operating room for hemostasis, and there were no cases of recurrent adenoid hypertrophy. There was no detectable difference in the incidence of postoperative complications. CONCLUSION: We conclude that this technique is safe and time-efficient, with the advantages of excellent visualization and essentially no operative blood loss.

    Title Ct Appearance of the Syed-neblett Device for Interstitial Brachytherapy of Gynecologic Malignancies.
    Date April 1997
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    Radiation therapy is an important adjuvant treatment for gynecological malignancies. However, the maximum amount of radiation treatment is limited by the side effects to the normal local tissue. We present a brief summary of the use and appearance of the Syed-Neblett intracavitary device. This device allows delivery of radioactive implants to a local tumor resulting in maximum dosage to tumor tissue, but limiting dosage to the surrounding normal tissue.

    Title Influence of Prone Position on the Extent and Distribution of Lung Injury in a High Tidal Volume Oleic Acid Model of Acute Respiratory Distress Syndrome.
    Date February 1997
    Journal Critical Care Medicine
    Excerpt

    OBJECTIVE: To evaluate the influence of body position on the extent and distribution of experimental lung damage in an oleic acid canine model of acute respiratory distress syndrome, using mechanical ventilation with high tidal volumes and positive end-expiratory pressure (PEEP). DESIGN: Prospective, randomized study. SETTING: Experimental animal laboratory. SUBJECTS: Twelve anesthetized and paralyzed dogs. INTERVENTIONS: Ninety minutes after lung injury was induced by injection of oleic acid, 12 animals were randomized to be ventilated for 4 hrs, in either the supine (supine group, n = 6) or prone (prone group, n = 6) positions, using the same ventilatory pattern (F10(2) 0.6, PEEP > or = 10 cm H2O, and a tidal volume that generated a peak transpulmonary pressure of 35 cm H2O when implemented in the supine position). Regardless of randomization to position, the tidal volumes, F10(2), and PEEP were kept constant and the pulmonary artery occlusion pressure was maintained between 4 and 6 mm Hg for the duration of the study. MEASUREMENTS AND MAIN RESULTS: At the end of the protocol, the lungs were excised for gravimetric determination (wet/dry weight ratio) and histologic examination (histologic score). Changes over time in the static pressure-volume curve of the lungs (obtained in the supine position) were also used as end-point variables. At baseline, hemodynamic and respiratory variables did not differ between groups. Just before randomization to position (90 mins after oleic acid injection), both groups presented similar lung static pressure-volume curves. Pulmonary artery occlusion pressure (4.3 +/- 1.9 vs. 4.8 +/- 1.3 mm Hg [supine vs. prone group]), cardiac output (4.1 +/- 0.4 vs. 5.2 +/- 1.3 L/min [supine vs. prone group]), and venous admixture (36.7 +/- 20.7% vs. 28.3 +/- 19.4% [supine vs. prone group]) were also not significantly (p > .05) different when measured in the supine position. At the end of the experiment, lung gravimetric data in the two experimental groups were not statistically different, suggesting a similar extent of edema. Histologic abnormalities, however, were less in the prone group than in the supine group (p < .01), due primarily to marked differences in extent and severity in the dependent regions of the lungs. Static lung compliance improved over time in the prone group (34 +/- 9 to 46 +/- 19 mL/cm H2O)(p = .02), but not in the supine group (34 +/- 6 to 36 +/- 6 mL/cm H2O). CONCLUSIONS: After oleic acid-induced lung injury, animals ventilated with high tidal volume and PEEP undergo less extensive histologic change in the prone position than in the supine position. The prone position alters the distribution of histologic abnormalities.

    Title Detection of Hepatocellular Carcinoma in Cirrhotic Patients: Sensitivity of Ct and Ultrasonography.
    Date November 1996
    Journal Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    Excerpt

    Patients with cirrhosis are at increased risk for the development of hepatocellular carcinoma. The heterogeneous hepatic parenchyma produced by cirrhosis makes detection of hepatomas more difficult. The purpose of this study was to determine the sensitivities of CT and ultrasonography for detecting hepatomas in cirrhotic patients. A retrospective analysis was performed of 733 patients who underwent liver transplantation at our institution. A study population of 21 patients was selected who met our inclusion criteria. The inclusion criteria required a pathologic diagnosis of hepatocellular carcinoma, pathologic evidence of cirrhosis, and contrast-enhanced CT and sonographic examinations performed within 1 week of each other. The sensitivities of CT and ultrasonography were determined by comparing the imaging findings with pathology findings from serially sectioned total hepatectomy specimens. A total of 40 hepatomas were detected pathologically in the 21 patients in our study population. CT identified 12 of 21 patients with hepatomas and detected 18 of 40 individual lesions (patient detection sensitivity = 57%, lesion detection sensitivity = 45%). Ultrasonography identified 14 of 21 patients with hepatomas and detected 21 of 40 individual lesions (patient detection sensitivity = 67%, lesion detection sensitivity = 51%). Combining the findings of CT and ultrasonography allowed identification of 17 of 21 patients with hepatomas and detection of 24 of 40 individual lesions (patient detection sensitivity = 80%, lesion detection sensitivity = 60%). We conclude that CT and ultrasonography have a low sensitivity for the detection of hepatocellular carcinoma in patients with cirrhosis.

    Title Systemic Venous Enhancement Patterns During Dynamic Abdominal Ct.
    Date October 1996
    Journal Clinical Imaging
    Excerpt

    In 25 patients we assessed the enhancement of abdominal venous structures during dynamic computed tomography (CT). The degree of venous enhancement demonstrated great variation. In six instances (out of 250 observations) a vessel was visually perceived as not enhancing and potentially thrombosed, including three gonadal veins. CT measurements were helpful in identifying enhancement, but were occasionally low enough that thrombosis remained a radiological consideration. The great variation in venous enhancement makes the diagnosis of thrombosis suspect, based on CT alone. Corroboration of this finding is suggested, when clinically relevant.

    Title Abdominal Aortic Coarctation: Ct, Mri, and Angiographic Correlation.
    Date October 1996
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    Abdominal aortic coarctation is an uncommon entity in the elderly. We present a case of abdominal aortic coarctation with computed tomography (CT), magnetic resonance imaging (MRI) and conventional angiographic correlation. CT and MR imaging detected an abnormal abdominal aorta distal to the origin of the celiac axis with the diagnosis of abdominal aortic coarctation confirmed by conventional angiography. Clinical presentation and diagnostic imaging findings depend on the level of the coarctation and its relationship to the renal vessels.

    Title A 24 Year Follow Up of an Isolated Lymphangioma of the Kidney.
    Date October 1996
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    Renal lymphangioma is a rare benign tumor of the kidney. An example is presented which was initially identified by excretory urography, angiography and biopsy. A 24 year follow up included computed tomography. The radiographic findings, pathogenesis and natural history of this unusual tumor are discussed.

    Title Case Report: Mri of Extrapancreatic Gastrinoma.
    Date October 1996
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    Islet cell tumors are a relatively rare group of neuroendocrine tumors that are often difficult to image preoperatively. We present the magnetic resonance imaging characteristics of an uncommon and unusually large extrapancreatic gastrinoma.

    Title Renovascular Hypertension.
    Date October 1996
    Journal Radiologic Clinics of North America
    Excerpt

    In current clinical practice, angiographic evaluation of patients with suspected renovascular hypertension usually follows clinical suspicion and positive captopril scintigraphy. Early digital angiography and percutaneous renal artery angioplasty have evolved as the accepted treatment pattern. Doppler sonography and MR angiography continue to be evaluated as potential methods of noninvasive screening.

    Title Superficial Dorsal Penile Vein Thrombosis (penile Mondor's Phlebitis): Ultrasound Diagnosis.
    Date September 1996
    Journal Journal of Clinical Ultrasound : Jcu
    Title Tracheal Gas Insufflation: Catheter Effectiveness Determined by Expiratory Flush Volume.
    Date August 1996
    Journal American Journal of Respiratory and Critical Care Medicine
    Excerpt

    Used adjunctively during mechanical ventilation, tracheal gas insufflation (TGI) improves CO2 elimination, principally by decreasing effective anatomic dead space. Continuing lung deflation at end- expiration raises the end-expiratory C02 concentration within the proximal airway, and could theoretically reduce the efficiency of a given catheter flow. To test this possibility, we designed a series of experiments that examined the influence of TGI delivery patterns on the efficiency of CO2 elimination. Using a gating device, catheter flow was delivered selectively during desired portions of expiration. Paralyzed, ventilated dogs were studied at short and extended inspiratory time fractions (TI/TT) with inspiratory tidal volume and ventilator frequency held constant. The expiratory flush volume, not the pattern of gas delivery, determined the observed decline in PaCO2, provided that the end-expiratory period was included in the catheter flush period. Despite continuing end-expiratory lung deflation (extended TI/TT), catheter effectiveness remained the same at matched expiratory flush volumes. To determine if enhanced distal mixing at the higher catheter flows required during the extended TI/TT (to match expiratory flush volume) masked a decrease in efficiency, we repeated the experiment with a tip-inverted catheter. We again found that matched catheter delivered expiratory volumes were similarly effective. With or without ongoing lung deflation, the volume of gas flushed during the expiratory period determined the effectiveness of TGI, provided that inspired minute ventilation remains unchanged and end-expiration is included in the catheter flush period.

    Title Transjugular Intrahepatic Portosystemic Shunt: Correlation of Portal Vein Velocity Measurements and Portosystemic Pressure Gradients.
    Date July 1996
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    To assess the relationship between portal vein velocity measurements and portosystemic gradients, color Doppler sonography was performed on 12 patients before and after transjugular intrahepatic portosystemic shunt placement. An additional patient was examined before and after shunt modification. The average maximum portal vein velocity increased from 15.7 cm s-1 before shunt placement to 43.5 cm s-1 after shunt placement, while the average portosystemic gradient decreased from 22.0 mm Hg before shunt placement to 7.9 mm Hg after shunt placement. Flow was observed within the shunt in 11 of the 12 cases. Shunt velocity was measurable in nine patients, with an average value of 115.7 cm s-1. Reversal of intrahepatic portal vein flow was observed in 10 cases following shunt placement. Color Doppler sonography is a useful non-invasive tool in the evaluation of intrahepatic portosystemic shunts, and changes in portal vein velocity correlate well with changes in the portosystemic gradient.

    Title Malignant Neoplasms Following Bone Marrow Transplantation.
    Date June 1996
    Journal Blood
    Excerpt

    We undertook an analysis of 2,150 recipients of bone marrow transplant (BMT) at the University of Minnesota to determine the incidence of post-BMT malignant neoplasms (MNs). Fifty-one patients developed 53 MNs, compared with 4.3 expected from general population rates (standardized incidence ratio [SIR], 11.6, 95% confidence interval [CI], 8.2-14.5). These included 22 occurrences of B-cell lymphoproliferative disorder (BLPD), 17 solid nonhematopoietic tumors, 10 myelodysplastic syndromes (MDS), 1 acute myelogenous leukemia (AML), 2 non-Hodgkin's lymphoma (NHL), and 1 Hodgkin's disease (HD). The estimated actuarial incidence of any post-BMT malignancy was 9.9% +/- 2.3% at 13 years posttransplant. The cumulative probability of BLPD plateaued at 1.6% +/- 0.3% by 4 years from transplant and factors independently associated with increased risk included in vitro T-cell depletion of marrow (relative risk (RR) = 11.9, P < .001), HLA mismatch (RR = 8.9, P < .001), use of antithymocyte globulin (ATG) for graft versus host disease (GVHD) prophylaxis (RR = 5.9, P < .001) or in the preparative regimen (RR = 3.1, P = .03) and primary immunodeficiency (RR = 2.5, P = .06). The cumulative probability of developing solid malignancy was 5.6% +/- 2.2% at 13 years from BMT. Malignant melanomas were the most common (SIR, 10.3, 95% CI 1.9 to 25.4). The actuarial incidence of MDS/AML plateaued at 2.1% +/- 0.8% at 9 years and was seen most often in older patients receiving autologous peripheral blood stem cells for HD or NHL. These data document that BMT recipients are at an increased risk of later malignancy, which may add significant morbidity and mortality to the transplant process. Methods for screening and identification of individuals at increased risk need to be addressed in future studies.

    Title Treatment of Head and Neck Hemangiomas with Recombinant Interferon Alpha 2b.
    Date June 1996
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Fifteen patients with head and neck hemangiomas were treated with systemic recombinant interferon alpha 2b (rIFNalpha2b, Schering). There were 14 infants and 1 adult in the group, ranging in age from 5 weeks to 24 years old. Of the 15 patients in the group, 5 had involvement of the airway. Three of the patients had previously failed alternative systemic therapy. Twelve patients have had a beneficial response. Ten patients have completed the therapy and have been off interferon from 6 to 53 months without reappearance or progression of the disease. Two patients are currently on the therapy with resolving lesions. Three patients had minimal response and underwent successful surgical resection. No major toxicity was encountered during the therapy. Our experience demonstrates that rIFNalpha2b is a well-tolerated and effective therapy for hemangiomas of the head and neck that require intervention.

    Title Mismatched Bone Marrow Transplantation for Omenn Syndrome: a Variant of Severe Combined Immunodeficiency.
    Date February 1996
    Journal Bone Marrow Transplantation
    Excerpt

    Omenn syndrome is a variant of SCID, inherited as an autosomal recessive disorder, and characterized by severe eczematoid dermatitis, eosinophilia, elevated serum IgE and a distinctive histology in enlarged lymph nodes. The etiology of Omenn syndrome is unknown, however, unlike other forms of SCID; patients with Omenn syndrome have activated T lymphocytes in their circulation capable of non-MHC restricted cytotoxic function. Recently, it has been observed that the use of immunosuppressive therapy, particularly cyclosporine, can modify the clinical manifestations of the disorder. Prior to the use of bone marrow transplantation this disease was universally fatal. Death typically occurred in infancy as the result of opportunistic infections and/or malignancies, most notably lymphomas. While bone marrow transplantation has become quite successful for many phenotypes of SCID, even with the use of alternative donors other than histocompatible siblings, in Omenn syndrome it remains a challenge. In our experience, patients with Omenn syndrome exhibit a higher incidence of Gram negative sepsis, before and during transplantation, and carry a significant risk of post-transplant rejection when compared with patients with other phenotypes of SCID. We report the results of six patients treated with bone marrow transplantation from alternative donors, three had unrelated donors (URD) and three had haplo-identical parental donors. Five of the six patients achieved complete and/or durable donor cell engraftment and only one patient experienced acute GVHD. Three patients died of transplant-related complications (infection or EBV-associated B cell lymphoma) between day +22 and day +95 post-transplant. Three patients survived more than 1 year post-transplant.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Efficacy of Expiratory Tracheal Gas Insufflation in a Canine Model of Lung Injury.
    Date September 1995
    Journal American Journal of Respiratory and Critical Care Medicine
    Excerpt

    Tracheal gas insufflation (TGI) improves the efficiency of CO2 elimination by reducing the CO2-laden dead space of the airways. The effect of TGI on PaCO2 diminishes in the setting of acute lung injury (ALI) because an increased alveolar component dominates the total physiologic dead space. Nevertheless, adopting a strategy of permissive hypercapnia should partially offset the decreased efficacy of TGI by increasing CO2 concentration in the proximal airways. To examine these issues we studied the CO2 removal efficacy of expiratory TGI as an adjunct to conventional mechanical ventilation (CMV) before and after oleic acid-induced lung injury (OAI). We first examined the effect of TGI before and after OAI, keeping tidal volume (VT) and frequency constant, and allowing PaCO2 to increase after OAI. We then tested TGI efficiency after matching PaCO2 after OAI to its pre-OAI level by increasing VT (post-OA/VT stage). PaCO2 was 53 +/- 3, 79 +/- 21, and 52 +/- 4 mm Hg in the pre-OAI, post-OAI, and post-OA/VT stages of CMV, respectively. The corresponding decrements in PaCO2 produced by TGI at a flow rate of 10 L/min were 16 +/- 3, 24 +/- 10, and 10 +/- 2 mm Hg, respectively. TGI decreased total physiologic dead space per breath (VD) by 56, 31, and 28 ml during the pre-OAI, post-OAI, and post-OA/VT stages, respectively. Despite a smaller reduction in VD during the post-OAI stage, the effect of TGI on PaCO2 was preserved because of the relatively high PaCO2 prior to its initiation.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title The Role of an Ethics Committee in Resolving Conflict in the Neonatal Intensive Care Unit.
    Date September 1995
    Journal The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics
    Title Abscess Formation As a Late Complication of Dropped Gallstones.
    Date August 1995
    Journal Abdominal Imaging
    Excerpt

    We describe a case of abscess formation 1.5 years postoperatively in a patient with dropped gallstones from laparoscopic cholecystectomy. The entity was initially recognized on computed tomography (CT) and the diagnosis was confirmed with ultrasound. Although this is a rare complication of laparoscopic cholecystectomy, it should be recognized as a potential source of abscess formation even in a patient presenting months after the procedure.

    Title Orbital Varix Presenting As a Subconjunctival Mass.
    Date June 1995
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    A 39-year-old woman presented with a vermiform superior conjunctival mass that progressively enlarged during 4 years of follow-up. Although magnetic resonance imaging suggested that the lesion was located in the superior forniceal conjunctiva, surgical exploration disclosed a vascular anomaly (varix) that extended deep into the orbit. The clinical features and management of orbital varices are discussed.

    Title Living Related Liver Transplantation: Request for an International Ethics Consultation from the Research Center for Surgery in Moscow.
    Date March 1995
    Journal Cambridge Quarterly of Healthcare Ethics : Cq : the International Journal of Healthcare Ethics Committees
    Title Doppler Sonography in the Posttransplant Patient: Use of Nifedipine to Detect Hepatic Arterial Flow.
    Date October 1994
    Journal Ajr. American Journal of Roentgenology
    Title Lymphoproliferative Disorders and Other Tumors Complicating Immunodeficiencies.
    Date August 1994
    Journal Immunodeficiency
    Excerpt

    Lymphoproliferative disorders and selected carcinomas which occur as complications of primary or secondary immunodeficiencies are frequently fatal. The incidence rates of these cancers vary from 1% to as high as 25% among specific groups of persons with primary (genetically-determined) immunodeficiencies as well as acquired immunodeficiencies, including immunosuppressed organ transplant recipients and individuals infected with HIV. Lymphoproliferative disorders including Epstein Barr virus (EBV) associated B cell lymphoproliferative disease (BLPD) and Hodgkin's disease represent the predominant category of tumors in both primary and acquired immunodeficiencies. EBV is an important cofactor common to many, but not all, B cell "lymphomas." Immunodeficient individuals who are at risk for developing EBV BLPD may demonstrate both inadequate immune responses to the virus as well as generalized immunoregulatory dysfunction reflected as imbalances in cytokine production favoring the proliferation of transformed B lymphocytes. Historically, the success of treatment of lymphoproliferative disorders in immunodeficiencies with conventional multi agent chemotherapies and/or radiation has been limited by unfavorable tumor response rates and high morbidity and mortality related to intercurrent opportunistic infections. With improvements in supportive care and the use of recombinant biologic response modifiers such as alpha interferon and/or other immunotherapies to treat EBV BLPD, survival of immunodeficient hosts following tumor diagnosis may improve. In addition to lymphoproliferative disorders, patients with congenital immunodeficiencies associated with IgA deficiency (including ataxia telangiectasia and Common Variable Immunodeficiency) are at increased risk for gastrointestinal carcinomas. Early detection and surgical excision of such tumors can result in prolonged survival in such patients.

    Title Renal Lymphoma in Castleman's Disease.
    Date August 1994
    Journal Clinical Imaging
    Excerpt

    An unusual case of renal lymphoma occurring in a patient with Castleman's disease is presented. The radiographic features and the relationship to the lymphoproliferative disorders, Castleman's disease, and multicentric angiofollicular lymph node hyperplasia are described.

    Title Liability Issues in the Management of Pain.
    Date July 1994
    Journal Journal of Pain and Symptom Management
    Excerpt

    Liability issues associated with pain management are important to health-care providers, patients, pharmaceutical companies, manufacturers of pain-management devices, health-care payors, and society at large. This article discusses five specific legal liability concerns: (a) health-care providers' liability to patients and/or exposure to professional discipline for inappropriate pain management, (b) health-care providers' liability to third parties for injury caused by patients treated for pain, (c) the legal distinction between pain management and euthanasia or physician-assisted suicide, (d) health-care payors' liability to patients for cost-containment decisions that impact on pain management, and (e) manufacturers' and health-care providers' liability for the risks and side effects of prescription drugs and pain-management devices.

    Title Legal Bases for the Control of Analgesic Drugs.
    Date July 1994
    Journal Journal of Pain and Symptom Management
    Excerpt

    Governments throughout the world have struggled for decades to ensure the availability of narcotic analgesics for legitimate medical and scientific purposes while controlling the abuse and illegal diversion of such substances. While the international drug-control system has effectively limited illicit trafficking of opioids, concerns remain about its effectiveness in ensuring the availability of these drugs for legitimate purposes. In the United States, federal legislation accommodates the use of controlled substances for medical and scientific purposes more effectively than does state law. Many states' controlled substance laws hinder appropriate opioid prescribing through (a) the use of ill-defined terms, (b) restriction of pain prescriptions to a specific number of dosage units; and/or (c) utilization of multiple-copy prescription programs. A more efficient state approach to monitoring inappropriate schedule II prescribing and dispensing may be through an electronic, computer-based pharmacy point-of-sale system, through which pharmacists can be alerted instantaneously to patients receiving the same drug from multiple pharmacies. In addition, states should consider modifying their approaches to drug abuse by adopting the revised Uniform Controlled Substances Act and/or establishing state pain initiatives.

    Title Intrahepatic Gas Formation Without Abscess After Hepatic Artery Thrombosis in the Setting of Liver Transplantation.
    Date June 1994
    Journal Clinical Imaging
    Excerpt

    We present a case in which intraparenchymal hepatic gas was observed in the absence of an abscess. This occurred following hepatic artery thrombosis in the setting of liver transplantation. An analogy is drawn to the postinfarction syndrome seen following therapeutic embolization and intrauterine fetal death. The unique features of the liver transplant and how they relate to the mechanisms of gas formation are discussed.

    Title Immunoregulatory Abnormalities in Patients with Epstein-barr Virus-associated B Cell Lymphoproliferative Disorders.
    Date May 1994
    Journal Transplantation
    Excerpt

    EBVirus-associated B cell lymphoproliferative disorder (BLPD) is a recognized complication of primary immunodeficiency and organ as well as bone marrow transplantation. Although the nature of the immune defects that predispose to the development of BLPD are unknown, it is postulated that aberrant T cell responses are involved. It is our hypothesis that unbalanced lymphokine production is a major contributory factor to abnormal B cell growth in response to EBV, resulting in BLPD. Since IFN-alpha and IL-4 are important regulators of B cell proliferation and also regulate the synthesis of IgE, we determined serum levels of IFN-alpha, IL-4, and IgE in 8 patients with newly diagnosed BLPD. Comparison was made to healthy recipients of organ transplants on immunosuppressive therapy without BLPD, and normal EBV seropositive controls. Levels of serum IL-4 were significantly elevated in both patients with BLPD as well as in healthy immunosuppressed organ transplant recipients as compared with normal healthy individuals. Patients with BLPD exhibited a combination of significantly lower levels of serum IFN-alpha, and significantly higher levels of serum IgE than either healthy EBV seropositive individuals or healthy recipients of organ transplants on immunosuppressive therapy. These results suggest that imbalance in the proportions of circulating cytokines favoring B cell proliferation may be contributing to the development of EBV-associated BLPD. The potential significance of the finding of low IFN-alpha in patients who develop BLPD is exemplified by our recent success in the treatment of BLPD with IFN-alpha and intravenous IgG.

    Title Immunosuppression: Preliminary Results of Alternative Maintenance Therapy for Familial Hemophagocytic Lymphohistocytosis (fhl).
    Date April 1994
    Journal Medical and Pediatric Oncology
    Excerpt

    Hemophagocytic lymphohistiocytosis (HLH) describes a group of disorders with similar clinical features that are associated with a very high mortality rate. Patients with HLH, and particularly the infantile form referred to as familial hemophagocytic lymphohistiocytosis (FHL), are often treated with multiple courses of epipodophyllotoxins, such as etoposide, for prolonged periods of time. Because of the concern regarding the risk of epipodophyllotoxin-induced acute myelogenous leukemia (AML) we have explored the use of immunosuppression as maintenance therapy for patients with FHL while they await the only known definitive treatment, i.e., bone marrow transplantation (BMT). We report 2 infants with FHL who had significant central nervous system involvement at diagnosis. Both were initially treated with etoposide, methotrexate, and glucocorticosteroids. Once clinical improvement was achieved these patients were successfully maintained in clinical remission of FHL on daily cyclosporine A (CSA) and glucocorticosteroids along with intermittent intrathecal methotrexate for 5 months until appropriate unrelated donors could be identified for BMT.

    Title Willingness to Perform Euthanasia. A Survey of Physician Attitudes.
    Date April 1994
    Journal Archives of Internal Medicine
    Excerpt

    BACKGROUND: In the United States, few studies have examined important variables in physician attitudes toward the practice of euthanasia, such as the patient's underlying disease, mental capacity, and age, and the physician's specialty and religion. We administered a case-based survey to analyze the impact of such specific variables on physician attitudes toward the practice. METHODS: A four-section survey solicited (1) physician responses to three hypothetical cases in which patients requested euthanasia; (2) physicians' general opinions about euthanasia and how its legalization might affect them personally and professionally; and (3) demographic information. Analysis focused on physicians' characteristics as they related to their responses to the various aspects of euthanasia elicited in the survey. Univariate and multivariate analyses, using logistic regression, were performed. RESULTS: Completed and analyzable surveys were returned by 740 physicians. We found that physicians felt more comfortable with euthanasia requests from nondecisional, nonterminal patients who had left advance directives than they did with requests from decisional patients suffering from grave illnesses or injuries, or from decisional patients who had early signs of a progressive but nonlethal neurologic disease. We also found that physicians' specialties and religions correlated with their responses to the hypothetical cases and with their generalized attitudes toward euthanasia. CONCLUSIONS: Given the disparity in responding physicians' attitudes toward euthanasia, along with the fact that values based on religious affiliation or profession may underlie many physicians' opposition to the practice, we conclude that if euthanasia is to be legalized, safeguards protective of patients and physicians must be incorporated.

    Title Variability of Hepatic Vein Doppler Tracings in Normal Subjects.
    Date March 1994
    Journal Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    Excerpt

    A prospective study was undertaken to determine the variability of hepatic vein Doppler waveforms in normal subjects. Seventy-five patients without liver or heart disease underwent Doppler examination of the middle hepatic vein. Normal triphasic tracings were observed in 68 subjects, while flattened tracings were observed in seven subjects. In addition, in four of the seven subjects with flattened tracings, an increase in pulsatility was seen during prolonged inspiration. We conclude that there is variability of hepatic vein tracings in normal subjects and that respiratory maneuvers can alter these tracings.

    Title Hepatic Mass in Budd-chiari Syndrome: Ct and Mri Findings.
    Date February 1994
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    We describe a case of Budd-Chiari syndrome, secondary to a hypercoagulable state, which produced a mass lesion on computerized tomography (CT) and magnetic resonance imaging (MRI) examinations. The mass simulated a tumor, but proved to be an area of hemorrhagic necrosis upon biopsy. The finding of a space occupying lesion may not always indicate a tumor in a patient with the Budd-Chiari syndrome. The causes, pathologic changes, and radiologic findings of Budd-Chiari syndrome are discussed.

    Title Images in Clinical Medicine. Transjugular Intrahepatic Portosystemic Shunt.
    Date January 1994
    Journal The New England Journal of Medicine
    Title Mr Imaging in Adults with Gaucher Disease Type I: Evaluation of Marrow Involvement and Disease Activity.
    Date July 1993
    Journal Skeletal Radiology
    Excerpt

    An investigation was conducted to determine the usefulness of magnetic resonance imaging (MRI) in the evaluation of bone marrow involvement in patients with Gaucher disease type I. T1- and T2-weighted images were obtained of the lower extremities of 29 adult patients. Patients were classified into one of three groups based on marrow signal patterns on T1- and T2-weighted images as well as change in signal intensity from T1- to T2-weighted images. An increase in signal intensity from T1- to T2-weighted images was the criterion for an "active process" within the bone marrow. Classification of the 29 patients produced the following results: group A: normal, 4 patients; group B: marrow infiltration, 16 patients; group C: marrow infiltration plus active marrow process, 9 patients. Correlation with clinical findings revealed that all nine patients with evidence of an active marrow process on MRI (group C) had acute bone pain. Conversely, only one of the remaining 20 patients (groups A and B) had bone pain. There was no correlation between disease activity and findings on conventional radiographs. We conclude the MRI provides an excellent noninvasive assessment of the extent and activity of marrow involvement in type I Gaucher disease.

    Title Color Doppler Sonography of Vascular Malformations of the Liver.
    Date July 1993
    Journal Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    Excerpt

    Nine cases of intrahepatic vascular malformations diagnosed using color Doppler sonography are described. These consisted of six cases of intrahepatic portal-hepatic venous shunts and three cases of arteriovenous fistulas. Among these is a case of multiple intrahepatic portal-systemic shunts. The sonographic findings and theories explaining the formation of vascular malformations in the liver are discussed.

    Title Ct Findings After Percutaneous Biliary Procedures.
    Date May 1993
    Journal Radiology
    Excerpt

    A prospective study was performed to determine the frequency, type, and extent of abnormalities depicted with computed tomography (CT) after percutaneous biliary procedures (PBPs). Abdominal CT scans were obtained 24-72 hours after the PBP in 31 consecutive cases in 29 patients. Fifteen abnormalities were proved with CT in 14 patients (45%), as follows: subcapsular hematoma (two patients), subcapsular or perihepatic fluid collection (three patients), intrahepatic hematoma (three patients), nonspecific intrahepatic fluid collection (three patients), subcutaneous hematoma at the puncture site (one patient), free intraperitoneal air (one patient), intraperitoneal collection of contrast material (one patient), and inadvertent transxiphoid catheter tract (one patient). Only five of these patients had clinically apparent post-PBP complications that could be explained with CT findings. The 14 patients with positive CT findings required more needle passes (mean, 8.3 vs 4.6) during the PBP, had a difficult PBP more often (five patients [36%] vs four patients [27%]), and had more frequent placement of an internal-external drain (nine patients [64%]) than those with negative findings (eight patients [53%]). Positive findings on CT scans are common after a PBP and often are not associated with clinical symptoms.

    Title Case Report: Massive Biliary Dilatation Mimicking Cystic Retroperitoneal Masses on Computed Tomography.
    Date April 1993
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    An unusual case is presented in which a massively dilated common bile duct produced a confusing CT image of multiple cystic areas within the abdominal cavity. Cholangiography and CT-cholangiography were useful in establishing the correct diagnosis. The differential diagnosis of cystic retroperitoneal masses is discussed.

    Title Prolonged Neutropenia Resulting from Antibodies to Neutrophil-specific Antigen Nb1 Following Marrow Transplantation.
    Date March 1993
    Journal Transfusion
    Excerpt

    Marrow graft failure is a significant cause of morbidity following bone marrow transplantation. A case is reported of marrow graft failure due to neutrophil antibodies. A 13-year-old girl with a large granular lymphocytosis and chronic neutropenia was treated with granulocyte transfusions prior to undergoing a transplant with bone marrow from a partially matched, unrelated donor. Following the transplant, a bone marrow biopsy showed engraftment of donor myeloid cells, but the recipient remained neutropenic. Testing of the serum for neutrophil antibodies found that the recipient's serum had a high-titer neutrophil antibody. Immunoprecipitation studies using the marrow recipient's serum and 125I surface-labeled neutrophils showed that the antibody reacted to the neutrophil-specific antigen NB1. Phenotyping of neutrophils from the marrow donor found that they expressed NB1 antigen, and, in a crossmatch assay, the recipient's serum reacted with donor neutrophils. Despite treatment with granulocyte-macrophage--colony-stimulating factor, the marrow transplant recipient remained neutropenic and died of polymicrobial sepsis and aspergillosis 38 days after the transplant. The presence of high-titer antibodies to neutrophil-specific antigen NB1 in this patient following transplant likely prevented the recovery of her peripheral blood neutrophils and contributed to her death.

    Title Paroxysmal Sneezing in Children: Two New Cases.
    Date March 1993
    Journal The Journal of Otolaryngology
    Excerpt

    Paroxysmal sneezing is an uncommon condition primarily affecting adolescents. Most of the reported cases were thought to be psychogenic, and only two were felt to be due to nasal sensitivity. This paper reports two adolescents with paroxysmal sneezing, neither of whom had apparent psychologic or emotional problems. In one child the sneezing continued during sleep. The other child was successfully treated with topical nasal anesthesia. Both children were felt to have nasal sensitivity as the etiology of their paroxysmal sneezing. The evaluation of the patient with paroxysmal sneezing requires a thorough history and physical examination. One must not assume that every case of paroxysmal sneezing is of psychogenic origin. Topical nasal anesthesia should be tried for control of intractable paroxysmal sneezing.

    Title Junctional Parenchyma: Revised Definition of Hypertrophic Column of Bertin.
    Date December 1992
    Journal Radiology
    Excerpt

    The so-called hypertrophic column of Bertin is a normal variation and simply represents unresorbed polar parenchyma of one or both of the two subkidneys that fuse to form a normal kidney. It contains renal cortex, pyramids, and columns (septa) of Bertin. (Since all elements of the tissue are normal, that is, neither hypertrophic nor a displaced or embryonic rest, it is referred to as "junctional parenchyma.") When a masslike lesion is suspected at sonography or excretory urography, diagnosis of junctional parenchyma can be made with a high degree of certainty when sonography shows that the structure (a) is located between the overlapping portion of two renal sinus systems, (b) is bordered by a junctional parenchymal line and defect, (c) contains renal cortex, pyramids, and columns of Bertin, and (d) contains renal cortex that is continuous with the adjacent renal cortex of the same subkidney.

    Title Primary Immunodeficiencies: Genetic Risk Factors for Lymphoma.
    Date October 1992
    Journal Cancer Research
    Excerpt

    It has been estimated that up to 25% of patients with certain genetically determined immunodeficiencies will develop tumors, primarily B-cell lymphomas, during their lifetime. Epstein-Barr virus appears to be an important cofactor in the development of lymphoproliferative disorders in patients with primary immunodeficiencies, as well as acquired immunodeficiencies. Additionally, host defects in immunoregulation and/or gene rearrangement, which are features of certain primary immunodeficiencies, probably contribute to the risk of lymphomagenesis in patients at risk.

    Title Unrelated Donor Bone Marrow Transplantation for Correction of Lethal Congenital Immunodeficiencies.
    Date July 1992
    Journal Blood
    Excerpt

    Unrelated donor marrow transplantation was undertaken in eight infants with severe combined immunodeficiency (SCID) and two children each with Wiskott-Aldrich syndrome (WAS) and Chediak-Higashi syndrome (CHS) who did not have histocompatible siblings. Donors for three patients were phenotypically matched at all HLA-A, B, Dr, and Dw loci, whereas nine donors were mismatched from the recipients at one of the HLA-A or B loci but phenotypically identical at evaluable D loci. All but one patient received conditioning chemotherapy and/or radiotherapy before infusion of donor marrow, which was not T-cell depleted. Prophylaxis for graft-versus-host disease (GVHD) consisted of methotrexate and prednisone combined with either cyclosporine A (six patients), antithymocyte globulin (five patients), or anti-CD5 ricin A chain immunotoxin (one patient). All patients engrafted with donor cells, and only 4 of 12 experienced any GVHD (1 of 8 SCID, 1 of 2 WAS, 2 of 2 CHS). Two children who developed grade II and two who developed grade III GVHD were successfully treated and all are now alive, off immuno-suppressive therapy, with no evidence of chronic GVHD greater than 18 months after transplant. Ten patients are alive with excellent immunoreconstitution greater than or equal to 1 year to greater than or equal to 3 years after transplant; actuarial survival is predicted to be 83% with a median follow-up of 2 years. Two children with SCID succumbed to pre-existing opportunistic infection early posttransplant. We conclude that closely matched unrelated donor bone marrow transplantation can correct congenital immunodeficiencies including variants of SCID, WAS, and CHS, with an acceptably low incidence of transplant-related complications, principally GVHD.

    Title Enzyme Augmentation in Moderate to Life-threatening Gaucher Disease.
    Date July 1992
    Journal Pediatric Research
    Excerpt

    Gaucher disease type 1 (GD type 1) is the most prevalent lysosomal storage disease and has its highest frequency in the Ashkenazi Jewish population. Deficiency of the enzyme, acid beta-glucosidase, results in the deposition of glucocerebroside primarily in macrophages. The accumulation of such "Gaucher cells" leads to visceromegaly, hepatic and bone marrow dysfunction, hypersplenism, and bony disease. Eleven GD type 1 patients, ages 4-52 y, with moderate to life-threatening manifestations, received 6-12 mo of enzyme augmentation with a macrophage-targeted acid beta-glucosidase preparation. Within 6 mo, substantial increases in Hb levels (mean = +30%) and platelet counts (mean = +39%) were observed. Hepatic and splenic volumes decreased by approximately 20% (range = 3-35%) and approximately 35% (20-52%), respectively. Hematologic and hepatic volume improvements were similar in the splenectomized (n = 4) and nonsplenectomized (n = 7) patient groups. In this patient population, no major differences were observed in the hematologic and visceral improvements with enzyme doses of 30, 50, or 60 IU/kg administered every 2 wk. Normal levels of acid beta-glucosidase activity were present in hepatic autopsy samples from one patient 11 d after enzyme infusion. In comparison, exogenous activity was absent from brain and lung specimens of the same patient. High levels (approximately 10-fold normal) were present in bone marrow samples from two patients obtained at 1 and 11 d after infusions. These studies demonstrate biochemical and clinical improvements by targeted enzyme augmentation in GD type 1, even in far advanced, life-threatening involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Carcinoid Tumor of the Lung Presenting As a Pleural Mass: Ct Diagnosis.
    Date May 1992
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    Carcinoid tumors of the lung typically arise centrally within the tracheobronchial tree. We report a rare case of a carcinoid tumor presenting as a pleural mass. The classification and X-ray features are described.

    Title Renal Aspergilloma: an Unusual Cause of Infection in a Patient with the Acquired Immunodeficiency Syndrome.
    Date April 1992
    Journal The American Journal of Medicine
    Excerpt

    The case of a 36-year-old man with the acquired immunodeficiency syndrome (AIDS) and a renal aspergilloma is reported. Aspergillus infections are uncommon in patients with AIDS. Isolated renal aspergillomas have rarely been reported in the non-AIDS population (14 cases) and have never been reported in a patient with AIDS. The patient we describe was clinically symptomatic and initially treated medically, but he did not respond to intravenous amphotericin and oral itraconazole. He eventually required nephrectomy; however, there was local recurrence of the aspergilloma postoperatively. We comment on some issues in the spectrum of Aspergillus infections in AIDS and review the literature on the manifestations and treatment of renal aspergillomas.

    Title Ethical and Legal Issues in the Use of Tpn.
    Date April 1992
    Journal Nutrition (burbank, Los Angeles County, Calif.)
    Title Is There a Right to Futile Treatment? The Case of a Dying Patient with Aids.
    Date December 1991
    Journal The Journal of Clinical Ethics
    Title B-cell Lymphoproliferative Disorders After Bone Marrow Transplant. An Analysis of Ten Cases with Emphasis on Epstein-barr Virus Detection by in Situ Hybridization.
    Date September 1991
    Journal Cancer
    Excerpt

    Ten patients with B-cell lymphoproliferative disorders (BLPD) after bone marrow transplant were studied in a retrospective analysis of 81 specimens available from biopsy and autopsy material. Histologic review, immunophenotyping, and in situ hybridization (ISH) for Epstein-Barr virus (EBV) sequences were done. Sixty-four specimens showed morphologic evidence of BLPD, demonstrating a heterogeneous spectrum with various degrees of plasmacytoid differentiation. Immunophenotypic evidence of clonality was found in six patients. The ISH detected EBV sequences in all ten patients, including 60 of the 64 specimens with morphologic evidence of BLPD. In addition, ISH identified EBV-infected lymphoid cells in two of 17 sites without morphologic evidence of BLPD. These data demonstrate the utility of ISH for detecting EBV genome in this setting and provide further evidence for the etiologic role of EBV in the pathogenesis of BLPD.

    Title Use of an Acoustic Transponder for Us Visualization of Biopsy Needles.
    Date September 1991
    Journal Radiology
    Excerpt

    A 20-gauge Chiba needle with a stylet embedded with polyvinyldifluoride (PVDF), a polymer that acts as an acoustic-electric transducer, facilitated a variety of diagnostic and therapeutic ultrasound (US)-guided interventions in nine patients. PVDF receives acoustic energy from the US scanner and transmits an electrical signal through the stylet and a shielded cable to the scanner, which results in appearance of a bright echo on the monitor at the location of the needle tip.

    Title Medial Indentation of the Inferior Vena Cava. A Sonographic Sign of Fluid in the Superior Recess of the Lesser Sac.
    Date July 1991
    Journal Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    Title Medical Discrimination Against Children with Disabilities: a Report of the U.s. Commission on Civil Rights.
    Date March 1991
    Journal Issues in Law & Medicine
    Title Comet-tail Artifact from Cholesterol Crystals: Observations in the Postlithotripsy Gallbladder and an in Vitro Model.
    Date October 1990
    Journal Radiology
    Excerpt

    The "comet tail" is a well-known ultrasound artifact that appears as a series of parallel bands radiating from a source. This artifact was observed in the gallbladder lumen in eight of 10 patients after extracorporeal shock wave lithotripsy of radiolucent calculi. To investigate the cause of the comet tail artifact, cholesterol crystals were studied in an in vitro model. The comet-tail appearance was reproduced in vitro and was found to be directly related to the interrogating frequency and the size of the crystal aggregates. The authors conclude that cholesterol crystals can serve as the source of the comet-tail artifact secondary to reverberation within the crystals.

    Title Giant Varices in Portal Hypertension: Ct Findings.
    Date September 1990
    Journal Computerized Medical Imaging and Graphics : the Official Journal of the Computerized Medical Imaging Society
    Excerpt

    Two cases of giant varices in portal hypertension are presented. Dynamic computed tomography (CT) was useful in establishing that the masses were in fact dilated veins.

    Title Hypogammaglobulinemia in Uremic Infants Receiving Peritoneal Dialysis.
    Date September 1990
    Journal The Journal of Pediatrics
    Title Sinus Histiocytosis with Massive Lymphadenopathy. A Rare Disease in the Differential Diagnosis of a Common Problem.
    Date August 1990
    Journal North Carolina Medical Journal
    Title Thyroid Dysfunction Following Bone Marrow Transplantation: Long-term Follow-up of 80 Pediatric Patients.
    Date July 1990
    Journal Bone Marrow Transplantation
    Excerpt

    Thyroid function was evaluated in children surviving disease-free for 2 years or more following bone marrow transplantation (BMT) for severe aplastic anemia (27 patients), acute non-lymphoblastic leukemia (28 patients), and acute lymphoblastic leukemia (25 patients). Pre-BMT conditioning consisted of high dose chemotherapy and total lymphoid irradiation with 750 cGy for patients with severe aplastic anemia, and for patients with leukemia, high dose chemotherapy and single dose total body irradiation with 750-850 cGy (33 patients) or fractionated total body irradiation with 1320 cGy (20 patients). Compensated hypothyroidism (elevated thyroid stimulating hormone (TSH) with a normal thyroxine index) occurred in 20/80 patients with a median time of onset of 12.3 months post-BMT (range 4-30). No patients developed primary hypothyroidism (elevated thyroid stimulating hormone with low thyroxine index). In seven patients, compensated hypothyroidism was transient with TSH returning to normal at a median of 60 months post-BMT (range 11-75). Six patients with compensated hypothyroidism received thyroid hormone replacement therapy. Time to development of compensated hypothyroidism was associated (p = 0.03) with underlying disease and radiation (11 of 27 patients with severe aplastic anemia + total lymphoid irradiation versus nine of 53 patients with leukemia + total body irradiation). In aplastic anemia patients, but not patients with leukemia, the incidence of thyroid hypofunction 5 years post-transplant was significantly higher (p less than 0.001) in those receiving methotrexate alone (82%) as prophylaxis for graft-versus-host disease compared with those receiving a regimen of methotrexate, antithymocyte globulin and prednisone (16%).

    Title Epstein-barr Virus-associated B-cell Lymphoproliferative Disorders in Immunodeficiency: Meeting the Challenge.
    Date April 1990
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Title Parry-romberg Syndrome in Association with Contralateral Poland Syndrome.
    Date March 1990
    Journal Journal of the American Academy of Dermatology
    Excerpt

    A 35-year-old woman had a 4-year history of skin depression on the right side of both the forehead and chin. A biopsy specimen showed a normal dermis and an absence of subcutaneous tissue. She also had Poland syndrome on the left side of the body, with loss of the sternocostal portion of the greater pectoral muscle. Significant cosmetic improvement was achieved with dermal fat grafts and silicone implants.

    Title The Artificial Heart As a Bridge to Transplant: Ethical and Legal Issues at the Bedside.
    Date March 1990
    Journal The Journal of Heart Transplantation
    Excerpt

    The healthy survival of two thirds of patients who receive the total artificial heart as a bridge to transplant is argument for continued use of this technology. Patient selection, informed consent, and treatment termination are the ethical and legal issues that are important at the bedside. Optimum patient selection requires clinical judgment, appropriate institutional review, and the elimination of socioeconomic barriers to transplant. Informed consent enables the patient to participate in the decision and to consider the question of treatment termination in a personalized fashion. Favorable public perception and successful implementation of this bridge to transplant are linked to the quality of this physician-patient communication.

    Title Effects of Chronic Ochratoxin A and Citrinin Toxicosis on Kidney Function of Single Comb White Leghorn Pullets.
    Date November 1989
    Journal Poultry Science
    Excerpt

    The objectives of the present study were to examine the effects of repeated or chronic ochratoxin A (OA) and citrinin exposure, and to determine if severe ochratoxicosis permanently alters renal function in pullets. The OA-treated birds were injected intramuscularly (breast muscle) with a 1 mg/mL solution of OA at a dose of .25 mg/kg BW or .5 mg/kg BW. Citrinin-treated birds were injected with a 6 mg/mL solution of citrinin at a dose of 6 mg/kg BW. Control birds received an equal volume injection of the citrinin and OA solvent, 100% ethanol, at a dose of 1 mL/kg BW. Kidney function was evaluated after 10 consecutive days of OA, citrinin, or ethanol injection, and 2 wk following the final injections. Venous blood gas measurements were taken after the seventh day of injection. The OA increased urine flow rate, decreased urine osmolality, increased ion excretion (Na, K, Ca, P), increased water consumption, increased manure moisture, and caused a relative alkalosis when measured immediately after 10 days of OA injection. These effects of OA were not detected 2 wk later. Citrinin increased manure moisture, decreased plasma P, increased the clearance of para-aminohippuric acid, and had no consistent effect on blood acid-base parameters. The results suggest that OA may cause an osmotic diuresis by inhibiting tubular reabsorption of electrolytes. The data also suggests that the effects of OA may be reversible simply by discontinuing toxin administration. Although the citrinin-induced increase in manure moisture indicates that citrinin had an effect on renal function, renal function analysis suggests that even repeated exposure to high doses of citrinin may only have a short duration of diuretic action on the kidneys.

    Title A Survey of Sued and Nonsued Physicians and Suing Patients.
    Date November 1989
    Journal Archives of Internal Medicine
    Excerpt

    To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians' practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians' practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients' and sued physicians' understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.

    Title Expression of Epstein-barr Virus Transformation-associated Genes in Tissues of Patients with Ebv Lymphoproliferative Disease.
    Date November 1989
    Journal The New England Journal of Medicine
    Excerpt

    Epstein-Barr virus (EBV) has been associated with serious or fatal lymphoproliferative disease in immunocompromised patients. EBV nuclear protein 2 and latent membrane protein are characteristically expressed in B lymphocytes proliferating in vitro in response to growth transformation by EBV. These two proteins are thought to be effectors of lymphocyte growth since they increase the expression of B-lymphocyte activation (CD23) and cell-adhesion (LFA 3 and ICAM 1) molecules in vitro. Using monoclonal antibody-immune microscopy, we have demonstrated that these two EBV proteins and their associated B-lymphocyte activation or adhesion molecules are expressed in the infiltrating B lymphocytes in immunocompromised patients with EBV lymphoproliferative disease. These monoclonal antibodies should be useful in the early diagnosis of EBV lymphoproliferative disease and in distinguishing it from other B-lymphocyte cancers associated with EBV, such as Burkitt's lymphoma. The finding of EBV nuclear protein 2 and latent membrane protein and their associated activation or adhesion molecules provides a further pathophysiologic link between EBV and the proliferation of B lymphocytes in immunocompromised patients.

    Title Congenital Cholesteatoma of the Middle Ear in Children.
    Date April 1989
    Journal The Journal of Otolaryngology
    Excerpt

    Congenital cholesteatoma, once considered to be a rarity, has shown an exponential increase in its incidence as evidenced by numerous clinical studies over the past decade. No explanation has been offered for this phenomenon. A review of the literature indicates that the definition of "congenital cholesteatoma" has strayed from the original one formulated by Derlacki and Clemis, which included a cholesteatoma medial to an intact tympanic membrane, without prior history of aural infections. Allowing patients with recurrent otitis media into studies may have contributed to a "false positive" rise in the incidence of this condition. This article reviews 19 cases of cholesteatomas behind intact tympanic membranes, treated at the Montreal Children's Hospital over a 10-year period. They represent 22% of the entire cholesteatoma population. There appears to be two groups of patients, each with a distinct clinical presentation that correlates well with the surgical outcome. Whether this implies different pathogenetic mechanisms remains unclear.

    Title Passive Smoking: a Review of Medical and Legal Issues.
    Date March 1989
    Journal American Journal of Public Health
    Title Otologic Manifestations in Congenital Velopharyngeal Insufficiency.
    Date February 1989
    Journal American Journal of Diseases of Children (1960)
    Excerpt

    A study of ear disease in children with congenital velopharyngeal insufficiency (VPI) was undertaken. A retrospective chart analysis of 80 cases of VPI formed the basis of this review. Thirty-seven percent of the children had evidence of middle ear disease, with middle ear effusion and recurrent otitis media being the most frequent findings. Thirty-one percent had abnormal audiograms, with 20% having a conductive or mixed hearing loss. Overall, 46% of the children had otologic manifestations, indicating the need for the pediatrician and the otolaryngologist together to be actively involved in the evaluation and treatment of this group of children, starting in early infancy.

    Title Case Report: Calcified Liver Metastases from Osteosarcoma.
    Date November 1988
    Journal The Journal of Computed Tomography
    Excerpt

    A case is presented in which calcified metastatic nodules in the liver from a primary osteosarcoma of the femur were demonstrated by computed tomography and magnetic resonance imaging.

    Title Relationship of Immunodeficiency to Lymphoid Malignancy.
    Date September 1988
    Journal The Pediatric Infectious Disease Journal
    Excerpt

    Individuals with either primary or secondary immunodeficiencies are at high risk to develop not only infections but also malignancy (especially of the lymphoid system). The major focus of this paper is on malignancies that develop in immunodeficiency syndromes, particularly malignancies in naturally occurring immunodeficiencies and following bone marrow transplantation (BMT). As of August, 1986, 514 cases of naturally occurring immunodeficiencies have been registered at the Immunodeficiency Cancer Registry. Overall non-Hodgkin's lymphomas predominate in these patients, accounting for 48.6% of all cases. Non-Hodgkin's lymphoma is the predominant malignancy in ataxia-telangiectasia, common variable immunodeficiency, Wiskott-Aldrich syndrome (WAS) and severe combined immunodeficiency (SCID). The histopathology of the lymphomas differs somewhat in each of the disorders. In WAS, large cell "histiocytic" lymphoma predominates, with most cases having the features of B lymphocytes, including pleomorphic immunocytoma and immunoblastic lymphoma. Non-Hodgkin's lymphoma in SCID also generally has B cell features and in some cases multiple copies of Epstein-Barr virus (EBV) genomic DNA have been found in tumor tissue. In contrast to ataxia-telangiectasia, in which non-Hodgkin's lymphoma is also the predominant neoplasm, the morphology and cell marker characteristics are more similar to those seen in nonimmunodeficient children. The lymphomas in ataxia-telangiectasia are very heterogeneous with representation from all the major histologic subtypes. We have found no relationship between the degree of immunodeficiency and the development of malignancy. Immunodeficiency following BMT, as in naturally occurring immunodeficiencies, appears to predispose patients to the development of lymphoid malignancy, especially for recipients of partially mismatched bone marrow. In Minnesota 8 patients have developed B cell lympho-proliferative disorders (BLPD) following BMT.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Otologic Findings in an Inuit Population of Cleft Palate Children.
    Date August 1988
    Journal The Journal of Otolaryngology
    Excerpt

    Otitis media with effusion is almost universal in infants with cleft palate. Inuit children have a very high incidence of otitis media. The otologic problems of Inuit infants and children with cleft palate have not previously been reported. The current study presents 14 Inuit children with cleft palate. All show significant otitis media with effusion or chronic otitis media with tympanic membrane perforation. The management of otitis media in this special population of cleft palate children is discussed.

    Title Epstein-barr Virus Associated B Cell Lymphoproliferative Disorders Following Bone Marrow Transplantation.
    Date June 1988
    Journal Blood
    Excerpt

    B cell lymphoproliferative disorders (BLPD) developed in eight patients following bone marrow transplantation (BMT) for leukemia (five patients) or immunodeficiency (three patients). Recipients of T depleted marrow from a mismatched donor were at particularly high risk of this complication. Six of 25 (24%) recipients of mismatched T depleted bone marrow developed BLPD. In contrast, none of 47 matched T depleted transplants, one of ten (10%) who received non-depleted marrow from an unrelated donor, and only one of 424 matched non-depleted transplants were associated with BLPD. Epstein-Barr virus (EBV) specific serology and DNA hybridization studies demonstrating five to 50 copies of EBV genome/cell in involved tissues implicate this virus as an associated etiologic agent. Restriction fragment length polymorphism (RFLP) and cytogenetic analysis of involved tissue demonstrated donor origin (five of seven) or host origin (two of seven). Histologic appearance was similar to EBV-induced polymorphic B cell proliferations described following solid organ transplantation, or which occur de novo in primary immunodeficiency. Six of seven patients with adequate tissue available for study were found to have monoclonal proliferations by: in situ immunofluorescence (six of seven), and/or immunoglobulin gene rearrangement, (four of six). Cytogenetic analysis of involved tissues from four patients showed a normal karyotype, whereas two had multiple clonal chromosomal abnormalities. Seven patients died despite aggressive attempts at therapy with combinations of antiviral, immunologic, and chemotherapeutic agents.

    Title Treatment of B-cell Lymphoproliferative Disorders with Interferon Alfa and Intravenous Gamma Globulin.
    Date June 1988
    Journal The New England Journal of Medicine
    Title Infant Care Review Committees: an Effective Approach to the Baby Doe Dilemma?
    Date April 1988
    Journal The Hastings Law Journal
    Title Button Battery Ingestion: a Case Report and Review of the Literature.
    Date November 1987
    Journal The Journal of Otolaryngology
    Excerpt

    Disc batteries represent a distinct type of pediatric foreign body because of their potential for severe morbidity and mortality. We present the case of an 18-month-old boy who ingested a lithium battery and, despite a delay in diagnosis, had a favorable outcome. Button batteries are being used with increasing frequency in a variety of devices including hearing aids, watches and calculators. Most contain a heavy metal such as mercury, and an alkaline electrolyte. Esophageal impaction results in a corrosive esophagitis leading to perforation with the attendant sequelae. Injury may occur by four mechanisms: (1) electrolyte leakage from batteries; (2) alkali produced from external currents; (3) mercury toxicity, and (4) pressure necrosis. Early diagnosis and urgent removal are required for esophageal impaction. More distal sites can be managed conservatively with spontaneous passage occurring in the majority of cases. Prevention should be directed at placing the cells out of reach and child-proofing battery-powered appliances.

    Title Molecular Genetic Rearrangements Distinguish Pre- and Post-bone Marrow Transplantation Lymphoproliferative Processes.
    Date October 1987
    Journal Blood
    Excerpt

    Chronic myelocytic leukemia (CML) may display a lymphoproliferative phase (lymphoid blast crisis) that is generally of B cell phenotype. Since lymphoproliferative disorders may occur following bone marrow transplantation (BMT), it may be difficult to distinguish posttransplant relapse of CML lymphoid blast crisis from de novo lymphoproliferation. Lymphoid blast crisis cells from a patient with CML displayed immunoglobulin heavy chain gene (C mu) rearrangement before BMT. Following BMT the patient developed a lymphoproliferative disorder involving multiple organs. Clonal rearrangement of C mu was demonstrated in several involved tissues. The rearranged C mu restriction fragment was distinct from that displayed before BMT. Additionally, rearrangement of the breakpoint cluster region (bcr) was demonstrated in the pretransplant blast crisis sample, but not in the posttransplant lymphoproliferation samples, thus confirming that these lymphoproliferative disorders were distinct. Molecular genetic techniques offer powerful diagnostic tools for monitoring the course of patients with CML undergoing BMT.

    Title Pruritus As a Presenting Sign of Acquired Immunodeficiency Syndrome.
    Date July 1987
    Journal Journal of the American Academy of Dermatology
    Excerpt

    A 65-year-old man with insulin-dependent diabetes developed intractable pruritus preceding weight loss and increasing fatiguability. Esophagogastroduodenoscopy revealed infection with Candida, cytomegalovirus, and Cryptosporidium. His T cell helper/suppressor ratio was inverted, and the serum human immunodeficiency virus (HIV) antibody was positive. Results of an extensive evaluation for internal malignancy were negative. Despite optimal care, the patient died 12 weeks after his initial hospitalization. We believe that HIV infection should be added to the list of underlying disorders that may present with pruritus.

    Title Mucocutaneous Findings in Acquired Immunodeficiency Syndrome/aids-related Complex Patients.
    Date May 1987
    Journal Journal of the American Academy of Dermatology
    Title Cutaneous Manifestations of Corynebacterium Group Jk Sepsis.
    Date March 1987
    Journal Journal of the American Academy of Dermatology
    Excerpt

    A 14-year-old boy developed group JK corynebacteria sepsis and a generalized erythematous macular and papular skin eruption following chemotherapy for relapse of acute lymphocytic leukemia. Lesional skin biopsy demonstrated effacement of eccrine glands by numerous pleomorphic gram-positive bacilli, morphologically consistent with Corynebacterium and confirmed by culture. This is the first known report documenting the generalized skin manifestations and histopathologic features associated with Corynebacterium sepsis.

    Title B-cell Lymphoproliferative Disorders in Children After Bone Marrow Transplantation: Radiologic Manifestations.
    Date March 1987
    Journal Radiology
    Excerpt

    The radiographic findings in five pediatric patients in whom unregulated B-cell lymphoproliferative disorders developed following bone marrow transplantation are described. Four patients received T-cell-depleted bone marrow from mismatched donors and one received nondepleted marrow from a matched sibling donor. These disorders are similar to B-cell lymphoproliferative disorders that have been described in other immunosuppressed hosts. They are associated with Epstein-Barr virus and range from polyclonal proliferation without cytogenetic abnormalities to monoclonal lymphoma with clonal cytogenetic changes. Unlike other postallograft lymphoproliferative processes, B-cell lymphoproliferative disorders in these patients have not responded to antiviral therapy, immunologic therapy, or chemotherapy. The radiographic patterns of disease include diffuse or focal hepatic involvement; gallbladder wall thickening; and pulmonary, soft-tissue, and basal-ganglion masses. These radiologic findings are not specific and evaluation of tissue histology is required for diagnosis.

    Title Living Will in Wisconsin.
    Date January 1987
    Journal Wisconsin Medical Journal
    Title Treatment Implications of the Postdischarge Contact.
    Date September 1986
    Journal Hospital & Community Psychiatry
    Title Nodules on the Hand of an American Agronomist Returning from Saudi Arabia. Acute Cutaneous Leishmaniasis.
    Date April 1986
    Journal Archives of Dermatology
    Title Medical Treatment of Defective Newborns: an Answer to the "baby Doe" Dilemma.
    Date October 1985
    Journal Harvard Journal on Legislation
    Title Epignathus: a Report of Two Cases.
    Date February 1985
    Journal Annals of Plastic Surgery
    Excerpt

    Two cases of epignathus are presented. The classification and clinical and radiological diagnoses are reviewed. Epignathi are rare embryological tumors, but with better preoperative assessment and awareness, safe surgical excision can be carried out. A careful long-term follow-up with regular examinations is essential to detect any residual lesions or extensions of the original embryological malformation.

    Title Crisis Therapy for Homosexuals.
    Date August 1984
    Journal Current Psychiatric Therapies
    Title Lorcainide Kinetics and Protein Binding in Patients with End-stage Renal Disease.
    Date June 1984
    Journal International Journal of Clinical Pharmacology, Therapy, and Toxicology
    Excerpt

    Lorcainide is a new antiarrhythmic drug undergoing clinical investigation for management of patients with ventricular arrhythmias. In this study we investigated the kinetic profile of lorcainide in nine patients with end-stage renal disease. A single intravenous bolus of 100 mg of the drug was injected while the patients were undergoing hemodialysis or during the off-dialysis period. Renal disease did not alter the kinetic properties of lorcainide; the elimination t1/2 beta during hemodialysis was 8.61 +/- 6.35 h, not significantly different from 7.04 +/- 4.12 h off-dialysis. Serum protein binding of lorcainide was investigated in vitro, and the percent binding of lorcainide to serum proteins of normal volunteers and renal or cardiac patients was not significantly different. These data suggest that renal disease should not alter either the dose or the dosing interval of lorcainide.

    Title Velopharyngeal Insufficiency Starting at Puberty Without Adenoidectomy.
    Date May 1984
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    At the Cleft Palate Unit of The Montreal Children's Hospital a number of patients are seen each year who developed velopharyngeal insufficiency after adenoidectomy. Each time one of these patients is seen, the question is asked: "What would have happened to the speech if adenoidectomy had not been done, and the adenoid had been allowed to undergo the normal process of atrophy at puberty?" We had not seen a patient develop velopharyngeal insufficiency at puberty without adenoidectomy until recently, when an 11.5-year-old boy presented with a history of hypernasality for 1.5 years. Physical examination revealed the soft palate to be slightly short but with good mobility. The voice was mildly hypernasal but there was no nasal escape. Radiologic investigation revealed a very deep nasopharynx with virtual absence of adenoid tissue and a slight shortness of the palate. The child had been on speech therapy and the recommendation was that the therapy be stopped. When the child was seen 2.5 months after cessation of speech therapy, the hypernasality had cleared completely. Speech Pathologists at other Cleft Palate Units were contacted and no similar cases were known. The literature also did not reveal any similar cases of velopharyngeal insufficiency developing after puberty in the absence of adenoidectomy and without a cleft palate.

    Title Hla-a1 and Steroid-induced Cataracts in Renal Transplant Patients.
    Date April 1983
    Journal Annals of Ophthalmology
    Excerpt

    Posterior subcapsular (PSC) lens changes were found in 32 of 33 steroid-treated renal transplant patients examined with the slit lamp techniques of direct and retroillumination. Only one of 33 age-matched controls had any PSC changes. Six (18%) of the renal transplant patients were bilaterally surgically aphakic because of PSC cataracts that developed while the patient was receiving steroid therapy after transplant surgery. Steroid-induced PSC cataracts were associated with the presence of human leukocyte antigen (HLA) A1, but not with the patient's age, cause of renal failure, total dose of steroids, or duration of steroid therapy.

    Title Partial Adenoidectomy.
    Date April 1983
    Journal The Laryngoscope
    Excerpt

    Adenoidectomy in the presence of an inadequate palate may result in velopharyngeal insufficiency. When an adenoidectomy is indicated in a child whose palate is not fully adequate, a partial adenoidectomy may be considered. Partial adenoidectomy involves removing the upper part of the adenoid for relief of nasal obstruction while leaving the lower portion of the adenoid intact to ensure velopharyngeal competence. Fifty-eight children underwent partial adenoidectomy over a 4-year period; 55 of these children had preoperative nasal obstruction; 49 had a tonsillectomy done at the same time; and 2 had had a previous T&A. The rationale for retaining the lower portion of the adenoid includes a short soft palate, decreased palatal mobility, a mild submucous cleft palate, huge tonsils pushing the palate anteriorly, and a short hard palate. The relief of nasal obstruction was excellent. There were no primary postoperative hemorrhages, and none of the 58 children developed velopharyngeal insufficiency following partial adenoidectomy.

    Title Unidirectional Absorption of Gentamicin from the Peritoneum During Continuous Ambulatory Peritoneal Dialysis.
    Date August 1982
    Journal Clinical Pharmacology and Therapeutics
    Excerpt

    Gentamicin kinetics were determined after intravenous or intraperitoneal injection in five patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Our objective was to determine rate of absorption of gentamicin from the peritoneum into the systemic circulation and vice versa. After intraperitoneal instillation of 1 mg/kg in the CAPD fluid during a 6-hr dwell time, the antibiotic appeared in the serum within 15 min in four of five patients. Peak serum concentrations ranged between 1.6 and 7.2 mg/l(mean +/- SD = 3.52 +/- 2.22) in all five patients and the time to reach peak concentration was 3.8 +/- 1.5 hr. Peritoneal gentamicin clearance was 13 ml/min. Percent extraction of gentamicin from the PD fluid within the 6 hr of intraperitoneal exposure ranged from 65% to 100% (mean +/- SD = 86.8 +/- 13.2). The fraction of the intraperitoneal dose absorbed into systemic circulation was found to be 0.84 independently by calculating the ratio of AUCip and AUCiv. When the same dose of gentamicin was injected intravenously (1 mg/kg), no gentamicin could be detected in the peritoneal fluid in three of five patients and only a very small amount of the drug was present for a brief period of time in the remaining two. The kinetic parameters of intravenous gentamicin were: volume of distribution, 0.3 l/kg; elimination rate constant, 0.028 hr(-1), plasma clearance 0.009 l/kg . min(-1), and half-life 27.4 hr. In two patients with acute peritonitis treated with intraperitoneal gentamicin, peak serum concentrations were found to range between 3.5 and 4.5 mg/l. These data suggest that gentamicin is rapidly absorbed from the peritoneal fluid into the blood compartment, but that occurrence of the reverse exchange is negligible. Thus, CAPD would not be expected to alter the elimination characteristics of intravenous gentamicin. Instillation of gentamicin in CAPD fluid may allow rapid absorption to reach therapeutic serum concentrations.

    Title Effect of Hemodialysis on Selected Physical Ocular Parameters.
    Date December 1981
    Journal Metabolic and Pediatric Ophthalmology
    Title Hepatitis B Surface Antigen in Urine of Renal Transplant Recipients.
    Date July 1981
    Journal Annals of Internal Medicine
    Title Long Custom-made Plastic Tracheostomy Tube in Severe Tracheomalacia.
    Date April 1981
    Journal The Laryngoscope
    Excerpt

    Tracheomalacia occasionally occurs after repair of esophageal atresia and distal tracheoesophageal fistula. It is usually mild, and tracheostomy is rarely necessary. In severe cases of tracheomalacia after repair of esophageal atresia and distal tracheoesophageal fistula, the tracheomalacia may extend below the tip of a regular plastic tracheostomy tube. A patient with just such a problem is presented. A custom-made long plastic tracheostomy tube was designed. A method of gluing the upper portion of a standard plastic tracheostomy tube to an uncuffed thin-walled polyvinyl chloride endotracheal tube was discovered and the technique is described in detail. The literature is reviewed concerning custom-made long plastic tracheostomy tubes and tracheomalacia in relation to esophageal atresia and distal tracheoesophageal fistula.

    Title Selective Deficiency in Collagen-induced Platelet Aggregation During L-asparaginase Therapy.
    Date January 1981
    Journal The American Journal of Pediatric Hematology/oncology
    Excerpt

    Platelet aggregation studies were performed on 10 pediatric patients with acute lymphoblastic leukemia (ALL) receiving induction therapy with vincristine, prednisone, and L-asparaginase. An isolated abnormality in platelet aggregation in response to collagen was found in all patients during the course of therapy. Platelet aggregation in response to collagen normalized following the discontinuation of L-asparaginase, while patients were still on vincristine and prednisone. In contrast to the abnormal collagen response, platelet aggregation induced by epinephrine, arachidonic acid, adenosine diphosphate (ADP), and thrombin were normal both during and following therapy. In the one patient with a normal platelet count before therapy, aggregation induced by all agents was normal. This selective abnormality in collagen aggregation therefore appears to result from therapy, with the use of L-asparaginase in particular being implicated.

    Title Massive Post-transplant Proteinuria with Minimal Histological Changes.
    Date July 1980
    Journal Transplantation
    Excerpt

    Three patients developed massive proteinuria, hypoalbuminemia, and edema after transplantation. These findings occurred in the immediate post-transplant period in two patients, and renal failure developed. The third patient developed proteinuria 4 months post-transplantation. There was complete remission of proteinuria in two patients and recovery of renal function in one. Renal histology was similar in all. Light microscopy demonstrated that the glomeruli contained a mild increase in mesangial matrix, but were otherwise normal. No significant interstitial cellular infiltration or fibrosis was present. Immunofluorescence microscopy revealed no staining for immunoglobulins or complement. Electron microscopy demonstrated fusion of foot processes, but the glomerular basement membrane was normal. No electron-dense deposits were found. The usual causes of post-transplant nephrotic syndrome were ruled out. We believe these three patients represent a unique disorder of the transplanted kidney.

    Title Temporal Bone Fractures in Children.
    Date December 1979
    Journal Otolaryngology and Head and Neck Surgery
    Excerpt

    Fifty children with temporal bone fractures were treated during a 40-month period. The diagnosis and management of temporal bone fractures in children is reviewed. The author's cases are classified as to longitudinal and transverse fractures, and the figures are presented for age distribution, sex, cause, loss of consciousness, CSF otorrhea, hearing loss, permanent tympanic membrane perforations, and facial nerve involvement. The author has followed a conservative method of management. Permanent impairment was not frequent, although all the patients with transverse fractures suffered total loss of hearing in the involved ear.

    Title Wiskott-aldrich Syndrome: Detection of Carrier State by Metabolic Stress of Platelets.
    Date August 1979
    Journal Lancet
    Excerpt

    A stress test has been designed which shows a consistent abnormality in platelets from carriers of the Wiskott-Aldrich-syndrome (W.A.S.) gene. 2-deoxy-D-glucose (D.D.G.), an inhibitor of glycolysis, completely inhibited second-wave adrenaline (epinephrine)-induced aggregation of platelets from 10 W.A.S. carriers, whereas it had no effect on the response of control platelets. Antimycin A (Ant A), an inhibitor of oxidative phosphorylation, had no effect on adrenaline-induced platelet aggregation of either carriers or controls. Incubation of control platelets with a combination of Ant A and D.D.G. inhibited aggregation in a way comparable to the effect of D.D.G. alone on carrier cells. Thus, W.A.S. carriers have a defect in platelet metabolism similar to that produced in normal platelets with Ant A. The D.D.G. stress test is a simple reproducible assay for detection of W.A.S. carriers.

    Title Nasal Septal Abscess.
    Date April 1979
    Journal Canadian Medical Association Journal
    Title Role of Renal Biopsy in End Stage Renal Failure.
    Date April 1979
    Journal Urology
    Excerpt

    The role of renal biopsy in 46 patients with end stage renal failure was assessed. Renal tissue was obtained by open renal biopsy in 24 patients, by needle biopsy in 5, and at bilateral nephrectomy in 17. In 4 patients the renal biopsy specimens showed advanced changes that could only be diagnosed as "end stage kidney". In 42 patients (91 per cent), a precise renal diagnosis was made. In 20 patients (43 per cent) the prebiopsy clinical impression differed from the histologic diagnosis. In the 29 patients undergoing renal biopsy, minor postoperative morbidity occurred in 5. We conclude that a renal biopsy in patients with end stage renal failure will result in a change in clinical diagnosis in a significant number of patients and can be performed with low morbidity.

    Title Platelet Storage Pool Deficiency and Prostaglandin Synthesis in Chronic Granulocytic Leukaemia.
    Date March 1979
    Journal British Journal of Haematology
    Excerpt

    Platelet function was evaluated in eight patients with chronic granulocytic leukaemia (CGL), seven Ph1 positive and one Ph1 negative. Seven of the eight patients' platelets had an absence of the second wave of adrenaline induced aggregation on at least one occasion, while five had impaired collagen aggregation. The platelets of all seven patients with abnormal responses to adrenaline, aggregated with arachidonic acid, thus ruling out a cyclo-oxygenase deficiency. A marked decrease in the ADP, serotonin, and dense body content of platelets was found in all five patients evaluated. Mixtures of CGL patient platelets with platelets from normal donors who had ingested aspirin gave a normal biphasic response to adrenaline. Normal release of the storage pool contents from aspirin treated platelets was shown by stirring a mixture of CGL platelets and 14C-serotonin labelled aspirin treated platelets with adrenaline. The CGL platelets alone or in the mixture produced malondialdehyde in response to adrenaline. These experimental results suggest that CGL platelets have a storage pool deficiency but can synthesize prostaglandins and thromboxanes in response to arachidonic acid and adrenaline.

    Title Surgical Repair of Complete Subglottic Stenosis.
    Date November 1978
    Journal The Journal of Otolaryngology
    Excerpt

    Two cases of complete subglottic stenosis, with absence of any subglottic airway, are presented. Both patients were treated via an anterior tracheo-crico-thyrotomy with excision of scar tissue. In both patients the newly created lumen was stented with Silastic covered with a buccal graft. One of these patients also had a hyoid bone autograft inserted between the cut edges of the cricoid ring. Both patients were successfully decannulated. The literature is reviewed in order to trace the history of the development of the procedures used.

    Title Epithelial Papilloma and Squamous Cell Carcinoma of the Nasal Cavity and Paranasal Sinuses: a Clinicopathological Study.
    Date February 1977
    Journal Cancer
    Excerpt

    Seventeen cases of intranasal epithelial tumors are reviewed. Thirteen were epithelial papillomas and four were squamous cell carcinomas associated with epithelial papillomas. In two cases followed over a 10 year period, transformation from an initial papilloma into a carcinoma was demonstrated. The histopathologic caracteristics of these lesions are described including the presence of prominent palisading and intraepithelial nesting in some tumors. The literature was reviewed for reports of carcinoma arising in previously benign epithelial papillomas. We suggest that squamous cell carcinoma may occasionally arise from a previously benign epithelial papilloma.

    Title Massive Post-transplant Proteinuria. Biopsy Proven Nil Disease.
    Date January 1977
    Journal Transplantation
    Excerpt

    A case of massive proteinuria following an A-match living donor transplantation is described. All attempts to define the cause of the proteinuria failed. The proteinuria resolved while the patient was on triple-drug therapy. Presently, the patient remains well with minimal proteinuria and excellent renal function.

    Title Malignant Degeneration of Nonirradiated Juvenile Laryngeal Papillomatosis.
    Date May 1976
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Malignant degeneration in nonirradiated juvenile laryngeal papillomatosis is exceedingly rare. Review of the world literature reveals one case in the English literature and two in the German literature. A 23-year-old patient, representing the youngest reported case in English literature, is presented.

    Title Letter: A Home-made Catheter for Peritoneal Dialysis in the Neonate.
    Date March 1976
    Journal The Journal of Pediatrics
    Title Letter: Vocal Cord Paralysis in Cystic Fibrosis.
    Date August 1975
    Journal The Journal of Pediatrics
    Title Parapharyngeal Rhabdomyoma.
    Date July 1975
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    Rhabdomyoma is a benign tumor of striated muscle origin that is very rare in young children. Review of the world literature revealed 20 cases of extracardiac adult-type rhabdomyoma in the head and neck area. All reported cases have been encapsulated and easily excised. A 22 1/2-month-old girl with a parapharyngeal rhabdomyoma is unique in that her tumor had atypical histology and lacked a capsule; it could not be "shelled-out".

    Title Sensitivity to Proteolytic Enzymes in Laundry Detergents.
    Date May 1971
    Journal The Journal of Allergy
    Title The Treatment of Contact Dermatitis.
    Date July 1968
    Journal Medical Times
    Title Allergic Aspects of Headache.
    Date March 1966
    Journal Medical Times
    Title The Importance of Field Studies and Meteorologic Factors in Pollen and Mold Surveys. A Three-year Report of Southern California.
    Date January 1966
    Journal Annals of Allergy
    Title Pollen and Mold Spores. An Atmospheric and Field Survey in Los Angeles.
    Date December 1965
    Journal California Medicine
    Excerpt

    A two-year survey of pollen and mold spores by the gravity slide method revealed that there are no clear-cut tree, grass or weed pollen seasons in California. Pollen counts should be correlated with field studies to distinguish the various plants whose pollen have a similar appearance. Spores of Alternaria and Hormodendrum, whose importance in allergic disease of the respiratory tract has been well established for many years, were found all during the year. More hormodendrum spores were collected than the total of all other pollens combined.

    Title Airborne Fungi in Los Angeles, California.
    Date November 1965
    Journal The Journal of Allergy
    Title Double Orifice Mitral and Tricuspid Valves.
    Date
    Journal Echocardiography (mount Kisco, N.y.)
    Excerpt

    Atrioventricular valve duplication is a rare congenital cardiac anomaly. The anomaly is usually recognized as an incidental finding at autopsy, open heart surgery, or two-dimensional echocardiography. In this article we present the transthoracic and transesophageal presentation of a case of mitral and a case of tricuspid valve duplication. The hemodynamic consideration of the lesions is discussed with a review of the literature. (ECHOCARDIOGRAPHY, Volume 13, January 1996)

    Title Coupling Temperature Sensing and Development: Hsp90 Regulates Morphogenetic Signalling in Candida Albicans.
    Date
    Journal Virulence
    Excerpt

    Hsp90 is environmentally contingent molecular chaperone that influences the form and function of diverse signal transducers. Here we discuss our recent findings that Hsp90 regulates the morphogenetic transition from yeast to filamentous forms required for virulence of the most prevalent fungal pathogen of humans, Candida albicans, and does so via cAMP-PKA signalling. This transition is normally regulated by environmental cues that are contingent upon elevated temperature to relieve Hsp90-mediated repression of the morphogenetic program. Intriguingly, Hsp90 inhibition induces filamentation independent of the canonical PKA transcription factor Efg1, in striking similarity to a select set of morphogenetic stimuli. Further investigation will determine the downstream transcription factors through which Hsp90 regulates morphogenesis and the precise mechanism of Hsp90's interaction with the cAMP-PKA pathway. C. albicans is one of many fungal species that undergo a morphological transition in a temperature-dependent manner, thus Hsp90's capacity to govern this key developmental program may provide insight into morphogenesis of diverse organisms.

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