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Biomedical subjects

A Norman

Publications and source records attributed to A Norman.

At least 109 records · Page 6Linked to original sources

Adaptive changes in locust kicking and jumping behaviour during development

The hind, or metathoracic, leg of a locust is specialised, enabling it to store energy that is used to extend the tibia rapidly during kicking and jumping; behaviours which share a common motor pattern. This study describes developmental changes in kicking and jumping behaviour and relates these changes to the development of the exoskeleton and jumping performance. In mature adults and intermoult larvae, the exoskeleton is strong and kicks can readily be elicited. Before and after the adult moult, when the exoskeleton is weak, kicks can be elicited less frequently, thus avoiding skeletal damage. At these times, animals do not generate the adult motor pattern for kicking, so that extension of the tibia is powered by direct muscle contraction, rather than through the release of stored energy. The muscles of all newly moulted animals are capable of generating sufficient force to damage the leg, but 14 days later the muscles can rarely generate sufficient force to damage the leg. To mimic the forces generated during the preparation for a kick, when the flexor and extensor tibiae muscles co-contract, the extensor muscle was stimulated electrically at a range of frequencies and the nature and occurrence of the resulting mechanical damage to components of the skeleton were assessed over a 14 day period following the adult moult. In newly moulted animals, the proximal femur partially collapses and thus protects the leg from damage before the muscles generate sufficient force to damage chronically other components of the leg. This partial collapse of the femur is reversible when the extensor muscle is activated at low frequency, but high frequencies cause permanent damage. The muscles of all animals 1 day after the moult are also capable of generating sufficient force to damage the leg, but the proximal tibia breaks most commonly in the region where the extensor muscle apodeme attaches. 5 days after the moult, the muscles in only 50 % of animals can damage the leg and most commonly the extensor muscle apodeme breaks. In mature animals, the only structure that fails is the extensor muscle apodeme, which fractures close to its point of attachment to the tibia. Damaging a metathoracic leg can significantly decrease the ability of a locust to jump and to compete for mates. Changes in the likelihood of damage to a metathoracic leg occur at predictable stages of development. Locust behaviour is modified during development, avoiding such damage.

Journal Article↗

Caffeine metabolism in patients with chronic liver disease.

An oral load of 200 mg (1030 mumol) caffeine (CA) was given to 13 patients with chronic liver diseases and to 11 healthy controls. The metabolism of CA was determined by following plasma concentrations and urinary excretion of CA and its metabolites. In addition, [2-14C]-caffeine was given orally to six patients to confirm the excretion through the different pathways. CA and its 14 main metabolites were separated and quantified by high performance liquid chromatography and capillary electrophoresis. Median (interquartile range) half-lives of CA were 19 (6.3-32) h in the patients and 3.8 (3.4-4.7) h in the controls. The wide range in the patients indicated varying degrees of liver dysfunction. Only 3 (2-4)% of administered CA was excreted unmetabolized in urine in the controls and the main degradation was through the paraxanthine (PX) pathway 82 (75-83)%. The combined theobromine (TB) and theophylline (TP) pathways (TB + TP) accounted for 15 (13-21)% of CA metabolism. Although the excretion of unmetabolized CA in the patients 6 (3-8)%, was similar to that in the controls, the metabolism through the PX pathway, 62 (44-65)%, decreased (p < 0.01 vs. controls), whereas the metabolism through the TB + TP pathways increased to 33 (30-47)%, p < 0.01. In controls, N3-, N7- and N1-demethylations were observed in 86 (83-89)%, 66 (62-70)% and 13 (9-18)%, respectively, of excreted metabolites. In patients the N3-demethylations, 71 (66-77)%, and N7-demethylations, 54 (48-59)%, decreased (p < 0.01 vs. controls), whereas N1-demethylation increased 30 (21-46)%, p < 0.01. The major C8-oxidation reaction, the oxidation of 1-methylxanthine, increased in patients (p < 0.01). We conclude that the slowed metabolism of CA in chronic liver disease is due to reduced N3- and N7-demethylations affecting biotransformation through the PX pathway.

Adult↗

Adaptive speckle reduction for improving the differential diagnosis of breast lesions.

Adaptive speckle reduction could mask diagnostic features and adversely affect diagnosis of focal breast lesions. Four radiologists assessed focal breast lesions (29 malignant and 31 benign) by blind review of representative static B-mode scans before and after adaptive speckle reduction processing, scoring 14 diagnostic features for breast cancer and recording their opinions on the diagnosis and on how adaptive speckle reduction affected interpretation of each feature. No adverse affect on diagnosis of malignant (P = 0.756) or benign (P = 1.000) breast lesions was found, despite some differences in scoring of the diagnostic features after adaptive speckle reduction. Observer recognition of most diagnostic features was easier after adaptive speckle reduction (e.g., edge definition [50% of cases], edge regularity [40%], lesion texture [44%], and lesion echogenicity [35%]).

Adult↗

Professional leadership in community nursing services.

To community nurses experiencing the chaos of repeated organisational change, the NHS can seem an environment hostile to clinical excellence. But, writes Alison Norman, the changing nature of health service management offers new opportunities for health visitors and school nurses to take the lead in pushing forward the boundaries of clinical practice. Here she examines the concept of leadership, and challenges practitioners to take up the gauntlet.

Community Health Nursing↗

Examination of fetuses after induced abortion for fetal abnormality--a follow-up study.

In the North-Western Region we offer a service to examine fetuses aborted after the diagnosis of fetal abnormalities. Many obstetricians use this service. We examined 343 mid-trimester fetuses over the last 5 years: 215 following an abnormal scan and 128 abnormal amniotic fluid or villus findings. When necessary, investigations were performed. A post-mortem examination was always required. As a result of fetal investigation, the scan diagnosis was modified or refined in 91 cases (42.3 per cent). In three of these cases no fetal abnormality was found. For the fetuses diagnosed as abnormal by amniocentesis or chorionic villus biopsy, in one (0.8 per cent) the pre-termination diagnosis was not confirmed. The results were similar to those of our previous 5-year study except (a) diagnosis of neural tube defects was rarely based on amniocentesis in the present study (2/62, 3.2 per cent) compared with the previous one (32/103, 31 per cent), and (b) renal abnormalities were more often diagnosed in the pre-termination scan in the present study. We conclude that the examination of aborted mid-trimester fetuses by dysmorphologists continues to improve diagnosis, allowing more accurate genetic counselling for the families.

Abortion, Induced↗

Cystic angiomatosis of bone with sclerotic changes mimicking osteoblastic metastases.

Five unusual cases of cystic angiomatosis of bone which presented with the radiologic appearance of osteoblastic lesions are reported. Three patients were female (ages 37, 41, and 65 years) and two were male (ages 24 and 66 years). Although cystic angiomatosis of bone usually produces widespread osteolytic lesions with a honeycombed appearance in the skeletal system, multiple osteoblastic lesions mimicking metastatic osteoblastic carcinoma are sometimes seen. This radiological presentation has not been well emphasized in previous reports. Histologically, in addition to the angiomatous lesions, both mature thickened lamellar bone trabeculae and immature trabeculae of woven bone were found. In one of our patients, increasing density of the osteoblastic lesions was noted over time. One previous study has suggested that the age of the lesions of cystic angiomatosis is related to radiographic density. It is important to recognize this uncommon variant of cystic angiomatosis and to include this entity among the radiologic differential diagnoses when multiple osteoblastic lesions are encountered.

Adult↗

Accelerated chemotherapy for poor prognosis germ cell tumours.

A pilot study has been completed of an innovative dose intensive chemotherapy schedule for poor prognosis patients with metastatic germ cell tumours referred to the Royal Marsden Hospital between August 1989 and January 1992. The rationale underlying the regimen was the use of an extremely short intercycle interval in order to counteract the potential of these tumours for rapid proliferation. The drug combination in the first phase incorporated a combination of cisplatin and carboplatin, infusional bleomycin and vincristine and this was followed by three cycles of bleomycin, etoposide and cisplatin (C-BOP/BEP). 21 patients with adverse presentations were treated with C-BOP/BEP. The median follow-up of surviving patients is 36 months (range 18-52 months). 1 patient died of disease, 1 died of a treatment complication while in remission and 1 further patient relapsed, and is in remission after radiotherapy and surgery. The 2-year overall survival rate was 90% [95% confidence interval (CI) = 77-100%]. We conclude that this approach may represent an improvement over standard chemotherapy and should be assessed in a multicentre setting.

Antineoplastic Combined Chemotherapy Protocols↗

Primary chemotherapy for stage II nonseminomatous germ cell tumors of the testis.

Between 1979 and 1989, 122 patients with clinical stage II testicular nonseminoma were treated with primary platinum-based combination chemotherapy following orchiectomy. Of the patients 58 had Royal Marsden Hospital stage IIA (nodes less than 2 cm. in diameter) and the other 64 had stage IIB (nodes 2 to 5 cm. diameter) disease. With a median followup after chemotherapy of 5.5 years, 118 patients (97%) were disease-free. Two patients died of progressive germ cell tumors, 1 of bleomycin toxicity and 1 of coincidental disease. The 5-year actuarial survival probability was 95% (95% confidence intervals 91 to 99%) and the 5-year failure-free survival probability was 92% (95% confidence intervals 88 to 97%). Tumor substage was not predictive of relapse but did indicate the probability of lymphadenectomy for a post-chemotherapy residual mass since this was performed in 17% of the patients with stage IIA disease and 39% with stage IIB disease (p < 0.05). Resected specimens contained mature teratoma (29), necrosis alone (5) or embryonal carcinoma (1). We conclude that for these clinical stages primary chemotherapy was as effective as primary lymph node dissection and a major operation was avoided in 68% of the cases.

Actuarial Analysis↗

Protracted venous infusion 5-fluorouracil and interferon-alpha in advanced and refractory colorectal cancer.

BACKGROUND: The management of patients with advanced colorectal cancer remains dependent on the optimal use of 5-Fluorouracil (5-FU). Enhanced 5-FU activity can be achieved by either adding a modulator or by altering the administration schedule, in particular using a protracted venous infusion. Based on encouraging phase II data using bolus 5-FU and interferon-alpha, we designed a study to investigate the activity of this modulator in patients with colorectal cancer refractory to protracted venous infusion 5-FU. PATIENTS AND METHODS: Patients with advanced colorectal cancer were treated with 5-FU (300 mg/m2/day) given as a protracted venous infusion via an indwelling central venous catheter and portable battery driven pump. At the time the tumour became refractory to 5-FU, interferon-alpha was added and further outcome evaluated. RESULTS: One hundred twenty-four patients were entered on the study, 118 of whom had measurable disease. Fifty-two patients had previously received chemotherapy. The overall tumour response rate with infusional 5-FU was 33% (38/118), however in previously untreated patients was 42% (29/69) and 18% in those given prior chemotherapy (9/49). At the point of refractory disease 64 patients had interferon-alpha added to the 5-FU. Five patients (8%) showed an objective partial response following interferon-alpha addition. Patient toxicities on infusional 5-FU included hand-foot erythroderma, stomatitis and diarrhoea. There were only 15 episodes of grade 3 or 4 toxicity. The addition of interferon-alpha gave fever, lethargy, myelosuppression and depression, but did not increase the incidence or severity of 5-FU related toxicities. Of 67 patients with tumour related pain, 53 (79%) had an improvement in their symptoms. Median survival of the whole group was 7.5 months. CONCLUSIONS: Protracted venous infusion 5-FU is an active and well tolerated palliative treatment for advanced colorectal cancer. The addition of interferon-alpha at the point of 5-FU refractory disease resulted in further significant response in a small number of patients. Further randomised studies, including quality-of-life end-points, are needed before the use of interferon-alpha can be recommended as a modulator of 5-FU in the clinical setting.

Adult↗

A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF).

PURPOSE: A phase II study was performed in patients with unresectable or metastatic gastric cancer evaluating the efficacy of a new chemotherapy schedule combining epirubicin and cisplatin with a continuous ambulatory infusion of 5-fluorouracil (ECF). PATIENTS AND METHODS: One hundred thirty-nine consecutive, previously untreated patients were given ECF. Of these, 128 had measurable disease. Epirubicin (50 mg/m2 i.v.) and cisplatin (60 mg/m2 i.v.) were administered every three weeks for 8 cycles during a 21 week continuous i.v. infusion of 5-fluorouracil (200 mg/m2/day). In total 773 cycles of chemotherapy were given. RESULTS: Objective tumour responses was seen in 91 (71%) of the 128 patients with measurable disease, of which 15 (12%) had a complete response. Twenty patients with locally advanced disease responding to ECF had attempted resection of the primary--11 (55%) were completely removed, 4 of these had no residual tumour in the resected specimen. The overall median survival was 8.2 months with 1 and 2 year survivals of 30% and 10% respectively. Grade 3 or 4 emesis occurred in 13%, stomatitis in 7%, diarrhoea in 4%, infection in 6%, leucopenia in 21% and thrombocytopenia in 8% of patients. Myelosuppression delayed treatment in 39 (5%) of the 773 cycles. Six of the 139 patients (4.3%) had treatment related deaths. There was no measurable reduction in quality of life during chemotherapy, while 67% of the 66 patients with dysphagia had complete resolution of this symptom. CONCLUSIONS: The ECF regimen displays high anti-tumour activity with moderate toxicity in patients with gastric cancer and in some cases enabled resection of previously inoperable tumours.

Adenocarcinoma↗

Induction of micronuclei in lymphocytes of patients undergoing excretory urography with ioversol.

RATIONALE AND OBJECTIVES: The hypothesis that nonionic contrast medium administered during excretory urography may cause cytogenetic damage was tested. METHODS: Micronuclei were scored in peripheral blood lymphocytes obtained from 33 patients before and after excretory urography with ioversol, a nonionic contrast medium. RESULTS: The examination resulted in a highly significant (sign test, P = .005) increase in the median (range) counts of micronuclei per 1,000 binucleate from 18 (0 to 31) before to 24 (5 to 40) after excretory urography. CONCLUSIONS: Nonionic ioversol produces a statistically significant increase in the chromosome damage of lymphocytes from patients undergoing excretory urography. This increase is similar to that reported for the ionic contrast media, ioxaglate and iothalamate, and equal to that produced by 6 to 7 cGy of 100-kilovolt x-rays.

Adult↗

Determination of caffeine and its metabolites in urine by high-performance liquid chromatography and capillary electrophoresis.

Caffeine (CA) and its 14 main metabolites were determined in urine by reversed-phase high-performance liquid chromatography (RP-HPLC) and capillary electrophoresis (CE). After addition of 1,3,9-trimethylxanthine, uracil and beta-hydroxyethyltheophylline as internal standards, samples were separated by RP-HPLC into three fractions; A, B and C. The fractions were concentrated by lyophilization and analysed quantitatively by CE. Fraction A contained 5-acetylamino-6-amino-3-methyluracil, 3-methyluric acid, 7-methyluric acid and 1-methyluric acid. Fraction B contained 7-methylxanthine, 3-methylxanthine, 3,7-dimethyluric acid, 1-methylxanthine, 1,3-dimethyluric acid and 3,7-dimethylxanthine, while fraction C contained 1,7-dimethyluric acid, 1,7-dimethylxanthine, 1,3-dimethylxanthine, 1,3,7-trimethyluric acid and caffeine itself. The detection limit for the various metabolites ranged from 2-5 mumol l-1. The within-run precision for the metabolites ranged between 3.6% and 15.2%. The combination of HPLC and CE techniques was found to be a practical and specific method for determination of CA and its metabolites in urine.

Caffeine↗

Intracapsular and paraarticular chondromas.

Intracapsular and paraarticular chondromas are rare benign tumors. The authors report four such lesions, three of which occurred about the knee and one at the hip. Radiographs showed calcified soft-tissue masses in the infrapatellar region of the knee in three patients. In the hip, the lesion was not visible on conventional radiographs. Three lesions originated from the joint capsule and one was extracapsular. These lesions should be differentiated from synovial chondromatosis and other calcified lesions occurring about the joints. After local excision, the tumors usually do not recur.

Aged↗

True telomeric translocation in a baby with the Prader-Willi phenotype.

We report on a baby with a nonreciprocal de novo unbalanced translocation between chromosomes 12 and 15. Her karyotype was 45,XX, -12, -15, +der(12)t(12;15)(pter-->qter::q13-->qter). The paternal origin of the 15q11-13 region was shown by DNA marker studies and, consistent with this, the baby had the Prader-Willi (PWS) phenotype. The breakpoint on 12q was distal to D12S11 (lambda MS43) which maps to 12q24.3-qter. Fluorescent in situ hybridization using the oligonucleotides (TTAGGG)7 and (AATCCC)7 showed that the 12q telomere was still present within the translocated chromosome. Thus, the translocation was within or onto the end of the telomere of 12q. This unusual translocation is further evidence of an unexplained instability of the 15q11-13 region.

Chromosome Banding↗