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Biomedical subjects

A C Roberts

Publications and source records attributed to A C Roberts.

At least 37 records · Page 2Linked to original sources
PubMed2000

Pulmonary embolism from pulse-spray pharmacomechanical thrombolysis of clotted hemodialysis grafts: urokinase versus heparinized saline.

PURPOSE: To compare the frequency and extent of pulmonary embolism (PE) occurring during pulse-spray pharmacomechanical thrombolysis (PSPMT) of clotted hemodialysis grafts with use of either urokinase (UK) or heparinized saline (HS). Postintervention primary patency and complication rates were compared for each method of thrombolysis. METHODS AND MATERIALS: Twenty-seven patients were enrolled in this prospective, randomized, double-blind study evaluating PE with two PSPMT agents. The doses of heparin were similar between groups. The only variable was that one group of patients received UK and the other received HS. In two cases, the venous anastomosis could not be crossed. Eleven patients were treated with UK and 14 with HS. Nuclear medicine perfusion lung scans were performed before treatment and after graft declotting procedures. Lung perfusion was quantified to 10% of a pulmonary segment (0 = normal perfusion, 1 = segmental perfusion defect), with nine segments counted for each lung. RESULTS: Baseline nuclear medicine perfusion lung scan results were abnormal (> or = 20% segmental perfusion defect) in 19 patients (70.4%). New PE (one or more pulmonary segments) occurred in two patients treated with UK (18.2%) and nine patients treated with HS (64.3%; P = .04). All cases of PE were asymptomatic. Quantitative global pulmonary perfusion analyses revealed that treatment with UK improved flow to 0.2 +/- 2.0 pulmonary segments, whereas treatment with HS decreased perfusion to 1.0 +/- 1.7 segments (P = .16, NS). Although postintervention primary patency rates were similar according to life-table analysis (P = .76, NS), complication rates were higher with use of HS (n = 4, 28.6%) than with use of UK (n = 2, 18.2%) (P = .6, NS). CONCLUSIONS: All PE were asymptomatic during PSPMT, but treatment with UK reduced the rate of PE and tended to result in smaller defects in lung scan results. Most patients undergoing hemodialysis have abnormal baseline perfusion scan results, but PSPMT with UK improved many of them. The postintervention primary patency rates were similar between groups, but complications were more frequent after treatment with HS.

Adult↗
PubMed2000

Adjunctive 3D US for achieving portal vein access during transjugular intrahepatic portosystemic shunt procedures.

PURPOSE: To evaluate the usefulness of information provided by three-dimensional ultrasound (3D US) and to determine whether 3D US decreased the number of passes required to obtain portal vein (PV) access during creation of transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS: Intermittent 3D US volume acquisitions were obtained during creation of TIPS in 20 patients. Useful information provided by 3D US was tabulated. The number of passes required to achieve PV access was recorded and results were compared retrospectively to 25 patients who underwent TIPS without 3D US. RESULTS: 3D US documented that the operator's opinion of which hepatic vein had been selected was incorrect in nine patients (45%), detected unfavorable PV anatomy that required modification of equipment or technique in seven patients (35%), permitted estimation of the trajectory required to access the targeted PV in all patients (100%), assisted in selecting the optimal point along the hepatic vein for origination of the needle pass in 11 patients (55%), allowed avoidance of a large hepatocellular carcinoma in one patient (5%), and confirmed that access into the main PV was intrahepatic in four patients (20%). The mean number of needle passes decreased from 10.4 in the historic control group to 4.6 in the 3D US group (P = .0001). CONCLUSION: 3D US provided imaging information that detected technical errors and altered anatomy, and provided positional and directional information to significantly improve needle pass efficiency.

Adult↗
PubMed2000

Adjunctive 3D US for achieving portal vein access during transjugular intrahepatic portosystemic shunt procedures.

PURPOSE: To evaluate the usefulness of information provided by three-dimensional ultrasound (3D US) and to determine whether 3D US decreased the number of passes required to obtain portal vein (PV) access during creation of transjugular intrahepatic portosystemic shunts (TIPS). MATERIALS AND METHODS: Intermittent 3D US volume acquisitions were obtained during creation of TIPS in 20 patients. Useful information provided by 3D US was tabulated. The number of passes required to achieve PV access was recorded and results were compared retrospectively to 25 patients who underwent TIPS without 3D US. RESULTS: 3D US documented that the operator's opinion of which hepatic vein had been selected was incorrect in nine patients (45%), detected unfavorable PV anatomy that required modification of equipment or technique in seven patients (35%), permitted estimation of the trajectory required to access the targeted PV in all patients (100%), assisted in selecting the optimal point along the hepatic vein for origination of the needle pass in 11 patients (55%), allowed avoidance of a large hepatocellular carcinoma in one patient (5%), and confirmed that access into the main PV was intrahepatic in four patients (20%). The mean number of needle passes decreased from 10.4 in the historic control group to 4.6 in the 3D US group (P = .0001). CONCLUSION: 3D US provided imaging information that detected technical errors and altered anatomy, and provided positional and directional information to significantly improve needle pass efficiency.

Adult↗
PubMed2000

The effect of dopamine depletion from the caudate nucleus of the common marmoset (Callithrix jacchus) on tests of prefrontal cognitive function.

This study examined the effects of depletion of dopamine from the caudate nucleus of the common marmoset (Callithrix jacchus), on tasks sensitive to prefrontal damage (attentional set-shifting and spatial delayed response). There was a marked impairment in performance on the spatial delayed response task, but performance on the attentional set-shifting task was relatively preserved except for an impairment in re-engagement of a previously relevant perceptual dimension. This pattern of impairment is distinct from that seen after excitotoxic lesions of the prefrontal cortex and in patients with Parkinson's disease. Though it is not possible to identify specific cognitive functions that are independent of dopaminergic modulation of the caudate nucleus, due to the partial nature of the lesion, the results do provide insight into those cognitive processes that appear most dependent on caudate dopamine.

Animals↗
PubMed2000

Inhibitory control and affective processing in the prefrontal cortex: neuropsychological studies in the common marmoset.

The orbitofrontal cortex has been ascribed a role in the inhibitory control, as well as in the emotional control, of behaviour. While damage to the orbitofrontal cortex in humans and non-human primates can cause inflexibility, impulsiveness and emotional disturbance, the relationship between these effects are unclear. Excitotoxic lesion studies in marmosets comparing the effects of cell loss within specific regions of the prefrontal cortex on performance of a range of behavioural tests reveal that mechanisms of response inhibition are not unique to the orbitofrontal cortex. Instead they are present in distinct cognitive domains for lowerorder as well as higher-order processing throughout the prefrontal cortex. Thus, the lateral prefrontal cortex is involved in the selection and control of action based upon higher-order rules while the orbitofrontal and medial prefrontal cortex may be involved in different but complementary forms of lower-order rule learning, their roles dissociable, as a result of their differential contribution to different types of associative learning.

Animals↗
PubMed2000

Early rethrombosis of clotted hemodialysis grafts: graft salvage achieved with an aggressive approach.

OBJECTIVE: The purpose of this study was to assess the efficacy of repeated pulsed spray pharmacomechanical thrombolysis for salvage of early rethrombosis of hemodialysis grafts and to identify factors that predict successful outcome. MATERIALS AND METHODS: Thirty-four patients with initial successful thrombolysis were referred for repeated thrombolysis because of early rethrombosis. Repeated thrombolysis occurred within 1 month of initial thrombolysis. Technical success and patency rates were calculated. Causes of graft thrombosis and procedural modifications were analyzed. RESULTS: The 39 rethrombosed grafts were successfully treated using pharmacomechanical thrombolysis, and patients underwent subsequent hemodialysis. The underlying flow-limiting stenoses were treated with balloon angioplasty using a larger balloon (41%), a same-size angioplasty balloon (18%), stent placement (15%), or increased anticoagulation (5%). A new stenosis location was discovered in 18%. Mean primary patency was 80.9 days (2.6 months) and secondary patency was 235.4 days (7.8 months). With life table analysis, 1-, 3-, 6-, and 12-month primary patency rates were 72%, 31%, 23%, and 15%, and secondary patency rates were 77%, 62%, 51%, and 31%, respectively. Graft patency rates in our study were compared with our institutional historic graft patency rates, with no significant difference noted (p = 0.76). No major procedural complications occurred. CONCLUSION: Adequate technical success and patency rates for pharmacomechanical thrombolysis occur even for hemodialysis grafts that rethrombose within 1 month. After thrombolysis, aggressive search for and treatment of additional stenoses are warranted.

Blood Vessel Prosthesis↗
PubMed2000

Does indermil glue improve success rates in myringoplasty? Interim analysis of a prospective trial.

The success rates of myringoplasty vary in the literature from 65 to 97.5 percent. Various reasons for failure are cited, one being failure of the graft to act as an adequate scaffold due to its falling away from the edge of the perforation. The potential role of adhesives in myringoplasty has been described but not objectively assessed. A group of 15 patients with a perforation of the tympanic membrane present for at least 6 months was prospectively recruited. All patients underwent myringoplasty using underlayed temporalis fascia. In each case the graft was spot welded to the edge of the perforation using Indermil (n-butyl cyanoacrylate) glue. At mean 7.7 months post operatively 14 grafts are intact (93%) and all patients have audiometric improvement (p < 0.01). These results are better then those from national audit statistics in the UK using conventional methods suggesting this technique is very promising. The technique and results are described.

Adult↗
PubMed1999

Performance norms for a rhesus monkey neuropsychological testing battery: acquisition and long-term performance.

A computerized behavioral battery based upon human neuropsychological tests (CANTAB, CeNeS, Cambridge, UK) has been developed to assess cognitive behaviors of rhesus monkeys. Monkeys reliably performed multiple tasks, providing long-term assessment of changes in a number of behaviors for a given animal. The overall goal of the test battery is to characterize changes in cognitive behaviors following central nervous system (CNS) manipulations. The battery addresses memory (delayed non-matching to sample, DNMS; spatial working memory, using a self-ordered spatial search task, SOSS), attention (intra-/extra-dimensional shift, ID/ED), motivation (progressive-ratio, PR), reaction time (RT) and motor coordination (bimanual task). As with human neuropsychological batteries, different tasks are thought to involve different neural substrates, and therefore performance profiles should assess function in particular brain regions. Monkeys were tested in transport cages, and responding on a touch sensitive computer monitor was maintained by food reinforcement. Parametric manipulations of several tasks demonstrated the sensitivity of performance to increases in task difficulty. Furthermore, the factors influencing difficulty for rhesus monkeys were the same as those shown to affect human performance. Data from this study represent performance of a population of healthy normal monkeys that will be used for comparison in subsequent studies of performance following CNS manipulations such as infection with simian immunodeficiency virus (NeuroAIDS) or drug administration.

Analysis of Variance↗
PubMed1999

Sign tracking in cuttlefish (Sepia officinalis).

Two groups of cuttlefish (Sepia officinalis) were used to demonstrate classical conditioning in this species and to determine whether the resulting approach response would be that of sign tracking or goal tracking. For cuttlefish in the paired condition, a flashing light was presented at one end of a long tank followed by food dropped into the center of the tank. For cuttlefish in the unpaired condition, food was dropped into the center of the tank either before or after the flashing-light stimulus. Paired cuttlefish oriented to the light, positioned themselves within striking distance, and occasionally attacked the light. Unpaired cuttlefish showed no reliable response to either stimulus. The results demonstrate that cuttlefish are capable of signal learning and that, under the conditions tested, cuttlefish sign tracked. This study begins a comparative analysis of learning in cuttlefish and offers a possible ecological advantage for sign-tracking behavior.

Animals↗