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Biomedical subjects

A Johnson

Publications and source records attributed to A Johnson.

At least 739 records · Page 41Linked to original sources
PubMedDate not supplied

Burned-and-battered adults.

The existence of a previously unrecognized group of patients, burned-and-battered adults, has been recognized. This retrospective review identifies some of the characteristics of the 41 burned-and-battered adults admitted to a burn center during a two-year period. The typical scenario was a domestic quarrel that included a male victim, a female assailant, and a scald injury involving the victims anterior trunk and upper extremity. The average burn size was 14% of the total body surface area. Four victims died as a result of their injuries. Although these victims represented only 10% of all patients admitted to the burn center, there may be many more undetected burned-and-battered adults. Only when the seriousness and magnitude of the problem are recognized can appropriate medical, legal, and social interventions be made to meet the needs of these burned patients.

Adult↗
PubMedDate not supplied

Parents' attitudes to developmental screening in the first year of life.

It has been suggested that screening for impairment in early childhood may cause anxiety to parents. Using self-administered questionnaires, we studied the attitudes and concerns of parents of infants aged 6 months and 8-9 months. Parents were randomly allocated to one of two groups. One group completed the second questionnaire after the 8-month assessment routinely performed by health visitors, and the other group completed the second questionnaire before the assessment. We showed changes in attitude and concerns over the 2-3 month period, but these were not related to the assessment. It appeared that particular concerns and anxieties were not resolved by a recent contact with a health visitor, although a high proportion of mothers stated that they found the assessment reassuring. There was some evidence of a lack of appreciation, both of the purpose of the tests and of the implication of test failure. Screening tests performed by health visitors at an age of 8 months do not appear to generate undue anxiety in parents. However, as many of the tests used are of doubtful validity, a review of the purpose and content of this early health visitor assessment is needed.

Attitude to Health↗
PubMedDate not supplied

Improvement in the regulation of cellular cholesterologenesis in diabetes: the effect of reduction in serum cholesterol by simvastatin.

Cellular cholesterol homeostasis was examined in 11 hypercholesterolaemic Type 2 diabetic patients prior to and following reduction of serum cholesterol using simvastatin, an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase. Following 12 weeks of treatment with simvastatin (10-40 mg day-1), serum cholesterol decreased by 30 +/- 3% from 7.8 +/- 0.2 mmol l-1 to 5.5 +/- 0.2 mmol l-1 (p less than 0.001) and LDL-cholesterol by 35 +/- 4% from 5.7 +/- 0.2 to 3.6 +/- 0.1 mmol l-1 (p less than 0.001). The esterified/free cholesterol ratio in LDL also decreased from 2.75 +/- 0.18 to 1.94 +/- 0.10 (p less than 0.01) after treatment. Cellular cholesterol synthesis, measured by [14C] acetate incorporation into mononuclear leucocytes, decreased by 39 +/- 11% from 231 +/- 13 to 140 +/- 25 mumol g-protein-1 (p less than 0.01). The degree of suppression of [14C]acetate incorporation into cholesterol in normal mononuclear cells by diabetic patients' LDL increased from 32.1 +/- 4.0% to 48.8 +/- 2.5% (p less than 0.001) following simvastatin. The activity of acyl coenzyme A:cholesterol-0-acyltransferase (ACAT) increased significantly by 55 +/- 18% (p less than 0.05) after treatment. Cholesterol synthesis in patients' mononuclear cells correlated positively (r = 0.66, p less than 0.05) with the esterified/free cholesterol ratio of their LDL, while suppression of cholesterol synthesis by patients' LDL correlated negatively (r = -0.64, p less than 0.05) with the esterified/free cholesterol ratio of the LDL following treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMedDate not supplied

Altered regulation of cholesterol metabolism in type I diabetic women during the menstrual cycle.

This study examines the relationship of cellular cholesterol metabolism to oestrogen and progesterone during the menstrual cycle in diabetic and non-diabetic subjects. Nine premenopausal diabetic women were compared to nine non-diabetic women of the same age. Oestrogen, progesterone, lipoproteins, including lipoprotein (a) (Lp(a)) and cholesteryl ester transfer protein (CETP) were determined in serum. Cellular cholesterol content and cellular cholesterol synthesis were measured in mononuclear leucocytes. There was no significant change in serum lipoproteins including Lp(a) during the cycle in either group. CETP activity was significantly higher over the 4 weeks in the diabetic patients compared with non-diabetic subjects (mean 463 +/- 30 mumol l-1 h-1 vs 405 +/- 28 mumol l-1 h-1, p < 0.01). Serum high density lipoprotein (HDL) cholesterol was significantly lower during the 4 weeks in the diabetic patients (1.7 +/- 0.1 mmol l-1 vs 1.8 +/- 0.1 mmol-1, p < 0.05). Cellular cholesterol synthesis decreased steadily up to the third week in cells from the control subjects whereas there was no significant change in cells from diabetic patients whose cellular cholesterol synthesis was higher at week 3 compared with non-diabetic subjects (663 +/- 54 nmol mg-1 cell protein vs 432 +/- 43 nmol mg-1 cell protein, two-way interaction p < 0.05). There was a significant negative correlation between cellular cholesterol synthesis and serum oestrogen in the non-diabetic subjects (p < 0.05) but not in the diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMedDate not supplied

Psychosocial outcomes of antiepileptic drug discontinuation. The Medical Research Council Antiepileptic Drug Withdrawal Study Group.

The MRC Antiepileptic Drug Withdrawal Study compared seizure control and the risk of relapse resulting from policies of slow discontinuation and routine maintenance of antiepileptic drug (AED) treatment in patients seizure-free for > or = 2 years. Because the decision to discontinue AEDs can have important psychosocial as well as medical consequences, we also sought to examine the psychosocial outcomes of the alternative policies Questionnaires were sent to eligible adults 2 years after their randomization. The response rate was 85%. There was little evidence of substantial effects of treatment policy on psychosocial outcomes, but seizure recurrence since randomization was associated with increased distress on several measures. However, receiving AEDs to control seizures was also associated with increased distress. Among patients for whom the risk of relapse after discontinuation appears low, the psychosocial benefits of discontinuation may be considerable.

Activities of Daily Living↗
PubMedDate not supplied

Failure of unipolar pacemaker secondary to subcutaneous emphysema.

Failure of a pacemaker to capture may be related to several factors. This report describes a case with loss of capture of a unipolar pacemaker following the development of subcutaneous emphysema. Once the diagnosis is established, treatment options include tube thoracostomy, pressure dressing, aspiration of air or fluid from the pocket, or insertion at a new site.

Aged↗
PubMedDate not supplied

Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence.

OBJECTIVE: To report our experience with intentional puncture of the intervening membrane ('septostomy') for the treatment of the twin oligohydramnios-polyhydramnios sequence (TOPS). METHODS: 12 patients were diagnosed with TOPS based on ultrasonographic findings. A 20- to 22-gauge spinal needle was used to puncture the membrane between the twins without any attempt at amnioreduction in 9 patients, while the procedure was combined with amnioreductions in 3 patients. RESULTS: Gestational age was 23.1 +/- 3.3 weeks at the time of septostomy and 31.1 +/- 4.4 weeks at delivery. Rapid accumulation of fluid around the 'stuck' fetus occurred in all cases following a single procedure. Three of the 24 fetuses died in utero and 1 died on the fifth day of life, for a combined survival of 83.3%. In the survivors, the septostomy to delivery interval ranged between 0.6 and 13 weeks (mean +/- SD 8.3 +/- 4.8). CONCLUSION: Amniotic septostomy is a promising new method for the management of TOPS and is associated with survival rates that are better than, or comparable to, more invasive modalities. A multicenter trial comparing septostomy to other modalities is warranted.

Amnion↗
PubMedDate not supplied

Fetal obstructive uropathy in trisomy syndromes.

Fetal obstructive uropathy has seldom been described in trisomy syndromes, and its relationship to these syndromes remains unclear. Five trisomic male fetuses, four with trisomy 18 and one with trisomy 21, were identified out of 110 fetuses evaluated for fetal obstructive uropathy. We performed detailed examination on the urinary tracts of four of these fetuses, three with trisomy 18 and one with trisomy 21, following termination in the second trimester. All four had a markedly distended urinary bladder (megacystis), abdominal wall distension, and a small, poorly developed urethra thoughout its full length. All four also had poor development of the prostate with virtual absence of glandular development, as compared to age-matched controls. Posterior urethral valves were not identified in any case. Three of the fetuses (two with trisomy 18 and one with trisomy 21) had unilateral or bilateral hydroureters, and resulting renal tubulocystic or glomerulocystic change. Review of this database reveals an unexpectedly high frequency of trisomies, particularly trisomy 18, suggesting that the relationship may not be coincidental. Abnormal prostate development may be causally related to fetal obstructive uropathies and may be an under-recognized trait in trisomy syndromes. Karyotypic analysis of all fetuses with obstructive uropathy is important since in utero surgical intervention may be contraindicated in cases of fetal aneuploidy.

Chromosomes, Human, Pair 18↗
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Audiologic findings in young patients with hypophosphatemic bone disease.

Audiometric tests were conducted on 19 subjects with hypophosphatemic bone disease to investigate whether auditory impairment like that reported in affected adults occurs in young patients. No hearing loss or significant auditory findings were noted among the children or young adult patients. However, sensorineural hearing loss of cochlear origin was identified in the three oldest subjects (40 to 58 years), although a history of noise exposure in two of them could explain the observations. The results indicate that if an association exists between hypophosphatemic bone disease and hearing impairment, the auditory signs will not develop until adulthood in treated patients. Additional studies of large populations of affected adults are needed to identify the incidence and mechanism(s) of the auditory system abnormalities and to assess any effect of medical therapy for the metabolic bone disease.

Adolescent↗
PubMedDate not supplied

An ink impregnation study of the migratory skin in the external auditory canal of the guinea-pig.

If the tympanic membrane or attic skin is wounded with a fine needle dipped in ink, ink particles are introduced into the epidermis and underlying tissue. These particles are subsequently taken up by cells in the epidermis and dermis. In this experiment the distribution of ink within the skin of ear canal was studied in nineteen guinea-pigs, one to ten days after wounding. Examination of the intact canal reveals that ink becomes distributed along a precise line from the wound to the point of desquamation. On sectioned tissue, the ink in this line is found to be mainly intracellular, initially in the epidermis, and subsequently in the upper dermis. When considered with other evidence, these results indicate that migration probably occurs in the deeper layers of the epidermis, and that it stops at the junction of the deep and superficial parts of the ear canal.

Animals↗
PubMedDate not supplied

In situ localization of F-actin in the normal and injured guinea-pig tympanic membrane.

Although cell migration is an important function of the epithelial cells of the tympanic membrane (TM), little is known about the distribution of the F-actin cytoskeleton, a contractile protein important in cell motility. The purpose of this experiment was to study the in situ localization of F-actin in the epithelial cells of the TM. F-actin, localized using Rhodamine-phalloidin, was present as a thin cortical band at the margin of both the mucosal cells on the inner side of the drum, and the suprabasal cells of the epidermis. The basal cells showed diffuse circumferential F-actin staining sometimes appearing as short microfilaments. Following a full thickness injury, changes in the distribution of F-actin could be observed with in situ localization. While the diffuse F-actin staining of the basal cells was reduced, both long F-actin microfilament bundles extending parallel to the long axis of the cell and focal aggregates of F-actin were prominent. The suprabasal cells became elongated, and while the F-actin remained localized to the cell margin, faint central F-actin microfilaments were observed. The staining of the mucosal cells remained unchanged. This study showed that the guinea pig TM is a useful model to study the distribution of epithelial F-actin in situ under normal and repair conditions, and that the basal cell layer may be important in regulating migration in the epidermis.

Actin Cytoskeleton↗
PubMedDate not supplied

The function of migratory epidermis in the healing of tympanic membrane perforations in guinea-pig. A photographic study.

During observations on healing traumatic perforations in guinea-pig tympanic membranes, a specific appearance was seen on the surface of the epidermis as it closed the perforations. In this experiment, this pattern was identified on 15 tympanic membranes in 10 guinea pigs, and serial photography was used to record the healing process in 6 perforations over 5 days. This study shows that epidermis accumulates at the inferior margin of the perforation (the side from which it migrates) and then closes over the defect. Epidermal migration appears to be a key factor in this healing process.

Animals↗
PubMedDate not supplied

Frequency-specific auditory brainstem responses in adults with sensorineural hearing loss.

The purpose of this study was to investigate the prediction of pure tone thresholds from auditory brainstem response (ABR) thresholds to tone bursts in noise using two formulae: (1) a correction factor based on the average difference between pure tone thresholds and ABR thresholds, and (2) a regression equation describing the relationship between pure tone thresholds and ABR thresholds. Twenty subjects with mild to moderate sensorineural hearing loss were tested with tone bursts having 1 millisecond rise-plateau-fall times in highpass noise (500 Hz) and notch noise (1000, 2000, and 4000 Hz). The data revealed that the pure tone-ABR threshold difference systematically decreased as frequency increased. Mean differences were approximately 25 dB at 500 Hz and 1000 Hz, 15 dB at 2000 Hz, and 10 dB at 4000 Hz. Using these correction factors, approximately 90 per cent of pure tone thresholds were predicted within +/- 10 dB at 2000 Hz and 4000 Hz, and within +/- 20 dB at 500 Hz and 1000 Hz. Similar results were found using the regression formulae. The results suggest that ABR thresholds to tone bursts in noise may provide valuable information on the auditory sensitivity and audiometric configuration of difficult-to-test patients.

Aged↗
PubMedDate not supplied

Hantavirus pulmonary syndrome in a Chilean patient with recent travel in Bolivia.

A case of hantavirus pulmonary syndrome (HPS) was serologically confirmed in a critically ill patient in Santiago, Chile. The patient's clinical course had many similarities to that of other HPS patients in North and South America but was complicated by acute severe renal failure. The patient's history included self-reported urban and probable rural rodent exposure during travel in Bolivia. Comparison of a viral sequence from an acute-phase serum sample with other known hantaviruses showed that the hantavirus nucleic acid sequence from the patient was very similar to a virus recently isolated from rodents associated with HPS cases in Paraguay.

Adult↗