[Specificity of the anesthetic consultation for ambulatory surgery].
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Ambulatory Surgical Procedures↗
Biomedical subjects
A Forster
Publications and source records attributed to A Forster.
Expression patterns of the human sarcoma-associated genes FUS and EWS and the genomic structure of FUS.
FUS (TLS) was first identified as the 5'-part of a fusion gene with CHOP (GADD153, DDIT3) in myxoid liposarcomas with t(12; 16)(q13; p11). Homologies were found with the EWS oncogene, which is rearranged in Ewing sarcomas and other neoplasias. The genomic structure of FUS shows extensive similarities with that of EWS, but the exon/intron structures differ in the 5' parts, and overall FUS is smaller than EWS. Exon 3 of FUS corresponds to exons 3 and 4 in EWS. FUS exons 4-6 correspond to EWS exons 5-8. Exons 7 to 15 of FUS are very similar to those in EWS, although the EWS exons are larger than the corresponding FUS exons. FUS and EWS were expressed in all tissues investigated. The transcripts were stable within the 160-min half-life experiments. No or little variation in FUS or EWS expression was seen when resting lymphocytes were activated. These observations indicate that FUS and EWS belong to the housekeeping type of genes. This view is supported by the presence of the housekeeping gene type of promoter region in both genes.
Amino Acid Sequence↗
Specialist nurse support for patients with stroke in the community: a randomised controlled trial.
OBJECTIVE: To evaluate whether specialist nurse visits enhance the social integration and perceived health of patients with stroke or alleviate stress in carers in longer term stroke care. DESIGN: Stratified randomised controlled trial; both groups assessed at time of recruitment and at 3, 6, and 12 months. SETTING: Patients with disability related to new stroke who lived in their own homes in the Bradford Metropolitan District. SUBJECTS: 240 patients aged 60 years or over, randomly allocated to control group (n = 120) or intervention group (n = 120). Intervention--Visits by specialist outreach nurses over 12 months to provide information, advice, and support; minimum of six visits during the first six months. The control group received no visits. MAIN OUTCOME MEASURES: The Barthel index (functional ability), the Frenchay activities index (social activity), the Nottingham health profile (perceived health status). Stress among carers was indicated by the general health questionnaire-28 (28 items). The nurses recorded their interventions in trial diaries. RESULTS: There were no significant differences in perceived health, social activities, or stress among carers between the treatment and control groups at any of the assessments points. A subgroup of mildly disabled patients with stroke (Barthel index 15-19) had an improved social outcome at six months (Frenchay activities index, Median difference 3 (95% confidence interval 0 to 6; P = 0.03) and for the full 12 months of follow up (analysis of covariance P = 0.01) compared with the control group. CONCLUSIONS: The specialist nurse intervention resulted in a small improvement in social activities only for the mildly disabled patients. No proved strategy yet exists that can be recommended to address the psychosocial difficulties of patients with stroke and their families.
Aged↗
An Mll-AF9 fusion gene made by homologous recombination causes acute leukemia in chimeric mice: a method to create fusion oncogenes.
Homologous recombination in embryonal stem cells has been used to produce a fusion oncogene, thereby mimicking chromosomal translocations that frequently result in formation of tumor-specific fusion oncogenes in human malignancies. AF9 sequences were fused into the mouse Mll gene so that expression of the Mll-AF9 fusion gene occurred from endogenous Mll transcription control elements, as in t(9;11) found in human leukemias. Chimeric mice carrying the fusion gene developed tumors, which were restricted to acute myeloid leukemias despite the widespread activity of the Mll promoter. Onset of perceptible disease was preceded by expansion of ES cell derivatives in peripheral blood. This novel use of homologous recombination formally proves that chromosomal translocations contribute to malignancy and provides a general strategy to create fusion oncogenes for studying their role in tumorigenesis.
Acute Disease↗
Neural network analysis of the EMG interference pattern.
This paper investigates the performance of artificial neural networks for analysing and classifying EMG signals from healthy subjects and patients with myopathic and neuropathic disorders. EMG interference patterns (IP) were recorded under maximum voluntary contraction from the right biceps of a total of 50 subjects. Parameters were obtained from the signals using recognized quantification techniques including turns analysis, small segments analysis and frequency analysis. Supervised networks examined were an improved backpropagation network (IBPN), a radial basis network (RBN), and a learning vector quantization network (INQ). Supervised networks using different combinations of parameters from turns analysis and small segments analysis gave diagnostic yields of 60-80%. Combinations using frequency analysis parameters produced similar results. The performance of unsupervised Self-Organising Feature Maps (SOFM) was generally lower than that of the supervised networks. Including personal data (sex and age) did not improve the overall performance.
Biomedical Engineering↗
The effects of solution concentration and epinephrine on lateral distribution of hyperbaric tetracaine spinal anesthesia.
In a search of a differential spinal block between dependent and nondependent sides, we investigated whether the use of a larger concentration of hyperbaric tetracaine (T) and/or the omission of epinephrine (E) would provide differential spread in patients left for 15 min in the lateral decubitus position. Spinal anesthesia was performed in the lateral decubitus position with the operated side dependent in 60 patients scheduled for lower limb surgery. All patients remained lateral for 15 min after spinal injection before being turned supine. They received 12 mg of T in 10% dextrose and E 0.2 mg was added when predicted duration of surgery was more than 90 min. The concentration of T to be used for each patient was randomized. This resulted in four groups of 15 patients: T 0.5% + E (control group), T 1% + E, T 0.5%, and T 1%. A unilateral anesthesia was defined as the presence of an adequate sensory (L-1 or higher) and/or motor (3 degrees) blockade on the dependent side and the absence of one or both modalities on the nondependent side, or as a duration of sensory (regression to L-2) and motor (1 degrees of recovery) blockade 20% longer on the dependent compared to the nondependent side. None of the 60 patients showed unilateral sensory block. A comparable number of patients in all groups showed unilateral motor block: four in T 0.5% + E, two in T 1% + E, four in T 0.5%, and five in T 1%. Likewise, a comparable number of patients in all groups showed a prolonged duration of sensory and motor block, respectively: six and eight in T 0.5% + E, six and nine in T 1% + E, six and eight in T 0.5%, and seven and seven in T 1%. In conclusion, although a preferential distribution of hyperbaric T toward the dependent side in patients of all four groups was noticed, the use of a larger concentration of T, omission of E, or combination of these two factors did not provide a more marked differential spread when compared to the standard solution of T 0.5% + E.
Adrenergic Agonists↗
Long term evaluation of septic arthritis in hemophilic patients.
Before 1983, septic arthritis was rare in patients with hemophilia. With the advent of human immunodeficiency virus infection in the hemophilia population, many centers noted an increasing incidence of patients with septic arthritis. Fifteen septic joints in 10 patients with severe hemophilia were documented. Eight patients were human immunodeficiency virus positive, 1 was human immunodeficiency virus negative, and 1 was not tested. The diagnosis was delayed in 5 patients because the symptoms are similar to an acute hemarthrosis. An elevated temperature was common. The white blood cell count was elevated in only 1/3 of the infections, being modified by human immunodeficiency virus infection. Associated risk factors included infected angioaccess catheters (2), pneumonia (2), and generalized sepsis (1). All but 1 joint responded to appropriate antibiotics and either repeated aspiration or arthrotomy. However, 6 patients died of acquired immunodeficiency syndrome from 2 to 109 months after infection. Three patients are alive 29, 86, and 96 months, respectively, after infection.
Adolescent↗
Hemiplegic shoulder pain (HSP): natural history and investigation of associated features.
The prevalence of hemiplegic shoulder pain (HSP) and associated factors was studied in patients with a stroke followed for 6 months after discharge from hospital. A questionnaire was used to evaluate shoulder symptoms and an examination of the shoulder and arm was carried out three times over 6 months. A total of 108 patients were studied with a mean age of 71 years. Sixty-nine patients (63.8%) developed HSP at some time during the study period. The number with HSP was 39 at discharge from hospital, 59 at 8 weeks post-discharge and 36 at 6 months. Nine carers reported lifting the patient by pulling on the hemiplegic arm, even though six of them had received advice about correct lifting techniques. Reduced shoulder shrug was associated with HSP at all times and reduced pinch grip was also associated with HSP at discharge from hospital. Patients who required help with transfers were more likely to suffer with HSP. There was no difference in the prevalence of HSP in patients treated at the day hospital compared to those who received domiciliary physiotherapy. It is concluded that HSP is common after a stroke and the prevalence increases in the first weeks after discharge from hospital. Stroke patients and their carers need advice about correct handling of the hemiplegic arm, and more work is required to ensure that correct handling occurs after discharge in patients at high risk of this unpleasant complication.
Activities of Daily Living↗
Association of erythroid transcription factors: complexes involving the LIM protein RBTN2 and the zinc-finger protein GATA1.
The RBTN2 LIM-domain protein, originally identified as an oncogenic protein in human T-cell leukemia, is essential for erythropoiesis. A possible role for RBTN2 in transcription during erythropoiesis has been investigated. Direct interaction of the RBTN2 protein was observed in vivo and in vitro with the GATA1 or -2 zinc-finger transcription factors, as well as with the basic helix-loop-helix protein TAL1. By using mammalian two-hybrid analysis, complexes involving RBTN2, TAL1, and GATA1, together with E47, the basic helix-loop-helix heterodimerization partner of TAL1, could be demonstrated. Thus, a molecular link exists between three proteins crucial for erythropoiesis, and the data suggest that variations in amounts of complexes involving RBTN2, TAL1, and GATA1 could be important for erythroid differentiation.
Adaptor Proteins, Signal Transducing↗
Incidence and consequences of falls due to stroke: a systematic inquiry.
OBJECTIVE: To undertake a systematic inquiry into the incidence and consequences of falls in a cohort of elderly patients with stroke after discharge from hospital. DESIGN: Administration of a questionnaire to patients and main carers at discharge from hospital and eight weeks and six months later. SETTING: Bradford Metropolitan District. SUBJECTS: 108 patients recruited to the Bradford community stroke trial. Patients were recruited to the trial if they were 60 years or over and resident at home with some residual disability. MAIN OUTCOME MEASURES: Number of falls, motor club assessment, Barthel index, Frenchay activities index, and Nottingham health profile. Stress in carers was indicated by the general health questionnaire. RESULTS: Of 108 patients, 79 (73%) fell in the six months after discharge from hospital with a total of 270 falls reported. Patients who fell in hospital were significantly more likely to fall at least twice at home after discharge (chi 2 = 8.16; P = 0.004). "Fallers" (two or more falls) were less socially active at six months and more had depressed mood. Carers of these patients were significantly more stressed at six months (53% v 18%; chi 2 = 8.5; P = 0.003). CONCLUSION: Stroke is associated with a risk of falling at home and affects the lives of patients with stroke and their carers. Falling and fear of falling is an important issue which needs to be dealt with by the multidisciplinary team.
Accidental Falls↗
The Na(+)-translocating ATPase of Acetobacterium woodii is a F1F0-type enzyme as deduced from the primary structure of its beta, gamma and epsilon subunits.
A 4.5 kbp EcoRI fragment hybridizing to a fragment of uncD (coding for subunit beta of F1F0-ATPases) was cloned from chromosomal DNA of Acetobacterium woodii. The nucleotide sequence was determined and revealed five open reading frames (ORF), four of which were identified to code for subunits of the Na(+)-ATPase. The deduced amino acid sequences of these ORF's are homologous to subunit alpha (partial coding sequence, C-terminal end), gamma, beta and epsilon of F1F0-ATPases from various organisms; furthermore, the organization of the genes in the order uncA (alpha), uncG (gamma), uncD (beta), uncC (epsilon) is identical to the structure of unc operon as present in most bacteria. Downstream of uncC is an ORF whose deduced amino acid sequence has 53% sequence homology to AlgD from Pseudomonas aeruginosa. The structure and organization of the unc genes are the final proof that the Na(+)-ATPase from A. woodii is a member of the family of F1F0-ATPases.
Acetobacter↗
Characterization of haemorrhages at the origin of the sternocleidomastoid muscles in hanging.
Haemorrhages at the periostal-clavicular origin of the sternocleidomastoid muscles were found in 52 out of 54 cases of death by hanging. This cervical haemorrhage is most frequently found in death by hanging, but only seldomly seen in other causes of death and can therefore be regarded as being typical for death by hanging. The frequency of this finding on the side of the highest point of the ligature mark is significantly higher, thereby supporting the hypothesis of extension as the causative mechanism. External cardiac massage and assisted breathing have no influence on the occurrence of haemorrhages. Histology shows the haemorrhages to be mainly directly epiperiostal, however, many cases displayed concurrent sub- and intraperiostal extravasations. Artificial post mortem production of these findings is discussed in the light of the literature.
Adolescent↗
Laparoscopic extraperitoneal inguinal hernia repair complicated by subcutaneous emphysema.
The case of a healthy 59-yr-old man who underwent elective laparoscopic extraperitoneal inguinal hernia repair and general anaesthesia is presented. After one hour of surgery, a sudden increase in the FETCO2 from 5.0% to 9.4% in relation to a massive subcutaneous emphysema, but without any haemodynamic instability, was noticed. The acute rise of FETCO2 was the first sign of an abnormal event. Nevertheless, subcutaneous emphysema was diagnosed with chest wall examination and palpation. Subcutaneous emphysema and hypercarbia are potential complications of laparoscopic surgery, but are more likely to occur in extraperitoneal surgery, since insufflated CO2 can diffuse easily into the surrounding tissues. High insufflation pressures will increase chances of this occurring and was the most likely cause of this complication. This case encouraged us to make recommendations for the management of laparoscopic extraperitoneal surgery which included: monitoring of CO2 insufflation pressure, routine examination and palpation of chest wall, use of N2O with caution, adjusting ventilation to physiological FETCO2 and excluding other causes of subcutaneous emphysema and hypercarbia.
Hernia, Inguinal↗
A study of hepatitis A virus infection among hemophilia patients in New York City.
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Hemophilia A↗
Hospital- and home-based rehabilitation after discharge from hospital for stroke patients: analysis of two trials.
We examined the methodology and results of two previously published randomized controlled trials of home- and hospital-based rehabilitation for stroke patients after discharge from hospital in Bradford and Nottingham, in view of apparently discrepant findings in the two trials. In an analysis of the combined findings of both studies, there was little difference in terms of efficacy between home- and hospital-based care, but a small advantage in favour of home therapy was found in reducing disability between hospital discharge and 6 months. Contrary to an earlier report, we did not find a differential effect of treatment between those who were and those who were not frail. We conclude that home therapy is the method of stroke after-care of choice in urban settings in the UK, although this conclusion may not apply in other health-care settings and further studies are required.
Activities of Daily Living↗
Quantitative evaluation of tourniquet leak during i.v. regional anaesthesia of the upper and lower limbs in human volunteers.
Although it is accepted that during i.v. regional anaesthesia (IVRA) local anaesthetic can leak under the tourniquet into the systemic circulation, no published study has evaluated this leak quantitatively. In volunteers, during two random sessions, we have simulated IVRA using standard techniques with a radiolabelled compound which is chemically similar to lignocaine and has comparable tissue distribution (0.1 mg of HIDA labelled with 100 muCi of 99mTc in 40 ml of saline). The decrease in radioactivity was measured with a gamma camera for the 20 min of tourniquet inflation and for the 20 min of washout after cuff deflation. While the tourniquet was inflated, the leak for the lower limb (mean 29 (SD 8) %) was significantly greater (P < 0.004) than the leak for the upper limb (15 (5) %). Moreover, in each of 10 volunteers, the leak was always greater for the lower than the upper limb. During the first 3 min after tourniquet deflation the loss of radioactivity was 58 (8) % of the maximal amount for the upper limb and 39 (8) % for the lower limb (P < 0.001). As the leak under the tourniquet was significantly greater for the lower than the upper limb, we conclude that IVRA for the lower limb can be associated more frequently with a shorter duration of successful anaesthesia and/or failure.
Adult↗
A prospective study of the feasibility of continuous spinal anesthesia in a university hospital.
A prospective study was undertaken in an elderly population undergoing orthopedic surgery to specifically study the feasibility of continuous spinal anesthesia (CSA). In a university hospital, 14 residents and 5 junior staff, using an 18-gauge needle and a 20-gauge catheter, performed 76 and 24 consecutive CSAs, respectively. There was an overall failure rate of 6%, all occurring in the residents' group. The causes affecting the success of CSA were inability to identify the subarachnoid space in 5/6 cases (all lumbar punctures were performed using the midline approach) and, in one case, inability to thread the catheter. The six failed CSAs were ultimately performed successfully by one of the senior authors. All surgeries were successfully performed with CSA, without requiring general anesthesia or intravenous narcotic supplementation. Anesthesia was initiated with isobaric bupivacaine in 94/100 cases. In 18% of patients, inadequate anesthesia prompted modifications of the local anesthetic solutions (i.e., type, baricity, total dosage) before surgery. One case of minor neurologic complication was observed, but no postspinal headache occurred. In conclusion, our findings led us to pursue CSA with large-bore equipment in an elderly population; furthermore, we believe that teaching the earlier use of alternative approaches other than the midline approach could further reduce our failure rate.
Aged↗
Prevalence and associated features of the cold hemiplegic arm.
BACKGROUND AND PURPOSE: Some stroke patients complain of an unpleasant sensation of coldness in the hemiplegic arm. This study aimed to determine the prevalence of this symptom and any associated features. METHODS: A questionnaire about symptoms in the arms was sent to patients at least 12 months after stroke. Reflex sympathetic dystrophy (RSD) was diagnosed if four typical symptoms were present in the arm. RESULTS: One hundred patients were recruited and 75 complete replies received. The mean age of the patients was 74 years, and the mean time since the stroke was 19 months. Forty patients (53%) experienced unilateral coldness in the hemiplegic arm. In 14 this sensation was constant, and 10 rated the symptom as troublesome. The symptom developed at a median time of 1 month after stroke, but only 13 patients (32%) sought advice from a doctor. Sensory symptoms and arm and shoulder pain were common, but the only symptoms associated with coldness were numbness (P < .001) and color change (P < .05). Fifteen patients fulfilled the diagnostic criteria for RSD, 13 of whom had coldness only in the hemiplegic arm. CONCLUSIONS: A sensation of coldness in the hemiplegic arm is common and distressing. It is associated with numbness and color changes in the arm. Some cases are caused by RSD, but other patients have coldness that may be due to other causes such as a vasomotor abnormality.
Aged↗