Biomedical subjects
Publications and source records attributed to A Robinson.
Endophthalmitis, attributable to Actinomyces viscosus, developed in a 78-year-old man after cataract surgery. Postoperative endophthalmitis with this organism is a rare occurrence. This report emphasizes the importance of the Actinomyces species as potential eye pathogens and presents antimicrobial susceptibility data for the isolate.
Explore the source record for details and available documents.
This paper explores issues concerning the development of linkages across the interface between acute and community aged care services in a small regional Australian city. It addresses a participatory action research project that took place over a 2 year period involving an Aged Care Assessment Team (ACAT). Aged Care Assessment Teams are multidisciplinary teams whose members mediate between hospitals and the aged care system in the community and have a key role in developing networks and linkages between various service providers in the field. In an age of economic rationalist-inspired reform agendas in health and community care, rural infrastructures have been compromised to such a degree that the role of rural ACAT in developing linkages between sectors has never been more important. This paper takes up this issue and addresses the project findings, which highlight a field characterised by ineffective linkages within and between the various sectors, a lack of understanding of the operation of the rural aged care system among nurses working in regional hospitals, and the efficacy of ACAT working collaboratively with nurses to create new and more effective linkages in aged care.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVES: To determine the prevalence of white coat hypertension and white coat effect among hypertensive pregnant women and to assess whether the presence of a significant white coat effect was associated with adverse pregnancy outcome when clinical management was based upon standard sphygmomanometric blood pressure recordings. DESIGN: Prospective blinded studies assessing the presence of a white coat effect. SETTING: Antenatal ward and pregnancy day assessment unit of St George Hospital, a teaching hospital in Sydney, Australia. POPULATION: One hundred and twenty-one hypertensive pregnant women in the second half of their pregnancy admitted to hospital or the day assessment unit for management of their hypertensive disorders. METHODS: Routine sphygmomanometric blood pressures were recorded by midwives in the ward or day assessment unit and awake blood pressure recordings were averaged. These blood pressures were compared with average awake blood pressures recorded by ambulatory blood pressure monitor (ABPM) (Spacelabs 90207, Seattle, Washington, USA). White coat hypertension was defined as an average sphygmomanometer blood pressure > or = 140 mmHg systolic and/or > or = 90 mmHg diastolic with awake ABPM average blood pressure within the normal range for ABPM-derived blood pressures in pregnancy, according to gestation. White coat effect was the difference between average sphygmomanometer blood pressure and average awake ABPM-derived blood pressure. All clinical management was based upon routine sphygmomanometer recordings and clinicians were blinded to ABPM data. MAIN OUTCOME MEASURES: Prevalence of white coat hypertension and white coat effect; maternal and fetal outcomes in those with and without a white coat effect of > or = 20 mmHg systolic and/or > or = 10 mmHg diastolic. RESULTS: Systolic and diastolic white coat hypertension were present in only 3.2% and 4.2% of the group, respectively. A systolic white coat effect > or = 20 mmHg was found in only 4.2% but 20.2% (26% for day assessment unit patients vs 15% for inpatients; P = 0.17) had a diastolic white coat effect > or = 10 mmHg. There was no difference in maternal or fetal outcomes between women with and without a white coat effect. CONCLUSIONS: White coat hypertension is an infrequent occurrence in mildly hypertensive pregnant women. Although a white coat effect is present more often, this is associated with clinical outcomes similar to women who do not exhibit this phenomenon. Using ABPM to identify a white coat effect in women presenting with hypertension in the second half of their pregnancy does not appear to be clinically useful.
An effective vaccine for serogroup B meningococci has yet to be developed and attention has turned to subcapsular antigens of the meningococcus as possible vaccine candidates. Iron binding proteins are being studied, with most interest focused on the transferrin binding proteins (TbpA and TbpB) and the ferric binding protein (FbpA). This study describes the purification of lactoferrin binding protein A (LbpA) from two meningococcal strains and assesses the human isotype-specific serum antibody response to these proteins in patients with proven meningococcal disease due to a range of phenotypes. Overall, fewer than 50% of sera contained IgG that recognised LbpA isolated from either strain and this antibody response was not uniform between the two proteins. There was some evidence that the antibody response varied between meningococcal phenotypes. This study demonstrates that LbpA does not induce a highly cross-reactive antibody response, indicating that it is unlikely to be an effective vaccine antigen.
Subjective and objective burden, psychiatric symptoms and coping strategies in a sample of 90 key relatives and other relatives of patients with schizophrenia, living in two European countries, were explored by means of well-validated questionnaires. The levels of burden on key relatives did not differ significantly from those on other relatives. Moreover, the risk of developing psychiatric symptoms was similar in the two subject groups at both centres. Significant correlations were found between key relatives and other relatives concerning the adoption of emotion-focused coping strategies. These data contrast with the current belief that family burden in schizophrenia is mainly a burden of key relatives, and they emphasize the need to provide supportive interventions for as many relatives as possible.
A golden retriever was presented with a prolonged history of a persistent lameness of the hindlimbs and the recent development of a plantigrade stance. Radiography showed bilateral chronic changes associated with the origins of both the lateral and medial heads of the gastrocnemius muscles. Surgical correction was carried out sequentially, with good results three months postsurgically and after a three-year follow-up.
Explore the source record for details and available documents.
OBJECTIVE: To describe the nature of the health care delivered to dependent adolescents throughout the military and compare services provided in adolescent medicine clinics with those provided in other medical departments and clinics. METHOD: Questionnaires were sent to physicians in pediatrics, internal medicine, family practice, primary care, emergency care, and adolescent medicine at 101 randomly selected military treatment facilities. A subsample of experts was selected to provide facility-specific, informed, representative information on the care provided to adolescents. RESULTS: Sixty-six percent (N = 345) of physicians returned completed questionnaires, providing information on 100% of the facilities sampled. More than half of responders felt that adolescents avoided care in their department. Two-thirds of all physicians, and three-fourths of the expert subsample, believed that adolescents are best served within adolescent medicine clinics. The expert subsample reported that adolescents served in facilities with adolescent medicine clinics received broader services. Only 28% of the facilities sampled provided any specialized adolescent medicine services. CONCLUSION: The military health care system has made progress in providing care to adolescent dependents, but reaching larger numbers of adolescents requires additional efforts.
PURPOSE OF THE STUDY: The aim of this paper is to report the outcome in four patients in whom the graft (bone-patellar tendon-bone) was dropped onto the operating-room floor during anterior cruciate ligament reconstruction, and was then re-implanted after decontamination by topic antibiotic treatment. MATERIAL AND METHODS: Between 1992 and 1996, 1038 anterior cruciate ligament reconstructions were performed. In four cases, the bone-patellar-tendon-bone graft was dropped onto the operating theater floor. The graft was then soaked in rifamycin at a concentration of 0.8 mg/ml in normal saline for 10 mn, and soaked in gentamycin at 0.6 mg/ml for a further 10 mn. Finally, the graft was washed in physiological saline. All cases had been given a loading dose of second generation cephalosporin (cefamandole), after deflating the tourniquet. Post-operatively, the patients were given amoxicillin and clavulanic acid for 15 days. The patients were reviewed radiologically and clinically (IKDC form) with a mean follow-up of 24 months. RESULTS: Post operatively all patients had an uncomplicated recovery. No wound problems was observed in 3 of the four patients achieved an IKDC grade A knee. The final patient had a grade B, after 55 month follow-up. All patients recovered their initial sport level. The radiological Lachman test shows a mean differential value of 0.3 mm. DISCUSSION: Dropping the graft during ACL reconstruction is a very rare problem. In this event, the surgeon can choose several options: Harvesting an other site, sterilizing the graft by irradiation, autoclaving, ethylene oxyde..., or using a topical antibiotic treatment. Cooper showed, in an in vitro study that the contamination rate was halved by antibiotic soaking of the graft. CONCLUSION: We used a topic antibiotic treatment with success in all four cases. We feel warranted the implantation of a graft which has been dropped, and then antibiotic soaked. The patient should of course be informed and told to report any sign or symptom of infection. On the strength of this result, we would like to propose a decontamination protocol which can be used in this sort of incident, fortunately very rare.
Neisseria meningitidis utilization of human serum transferrin (hTF)-bound iron is an important pathogenicity determinant. The efficiency of this system would clearly be increased through preferential binding of diferric hTF over the iron-free form. To characterize this process, functionally active meningococcal transferrin-binding protein A (TbpA) and TbpB have been purified from N. meningitidis using a novel purification procedure. The association of isolated Tbps and Tbps in the presence of hTF was investigated by gel filtration. Co-purified TbpA+B formed a complex of molecular mass 300 kDa which bound 1-2 molecules of hTF. Purified TbpA formed a complex of 200 kDa, indicating association as a dimer, whereas TbpB aggregated to form multimers of variable sizes. On recombining TbpA and TbpB, a stable complex of equivalent size to co-purified TbpA+B was formed. This complex may be composed of a single TbpA dimer and 1 molecule of TbpB. The technique of surface plasmon resonance (SPR) was used to demonstrate clearly that TbpB of either high (85 kDa) or low (68 kDa) molecular-mass preferentially bound diferric hTF in comparison with iron-free hTF. This selectivity was not observed with TbpA, but was found at low levels with co-purified TbpA+B. Individual TbpA and TbpB, recombined in a 1:1 molecular ratio, showed iron-mediated discriminatory binding at an intermediate level. SPR was also used to show that TbpA and TbpB bound to distinct regions of hTF, and that prior saturation with TbpB reduced subsequent TbpA binding. The results demonstrated that hTF bound more TbpA than TbpB, with an approximate ratio of 2:1. We have demonstrated that in vitro, TbpA+B exists as a receptor complex composed of a TbpA dimer and one molecule of TbpB, and that TbpB selectively binds diferric hTF. We propose that, in vivo, TbpA and TbpB also exist as a receptor complex, with TbpB selectively binding diferric hTF, bringing it close to TbpA, the transmembrane component, where the ferric iron can be transported to the periplasm.
Explore the source record for details and available documents.
Since 1989, about 570 different p53 mutations have been identified in more than 8000 human cancers. A database of these mutations was initiated by M. Hollstein and C. C. Harris in 1990. This database originally consisted of a list of somatic point mutations in the p 53 gene of human tumors and cell lines, compiled from the published literature and made available in a standard electronic form. The database is maintained at the International Agency for Research on Cancer (IARC) and updated versions are released twice a year (January and July). The current version (July 1997) contains records on 6800 published mutations and will surpass the 8000 mark in the January 1998 release. The database now contains information on somatic and germline mutations in a new format to facilitate data retrieval. In addition, new tools are constructed to improve data analysis, such as a Mutation Viewer Java applet developed at the European Bioinformatics Institute (EBI) to visualise the location and impact of mutations on p53 protein structure. The database is available in different electronic formats at IARC (http://www.iarc. fr/p53/homepage.htm ) or from the EBI server (http://www.ebi.ac.uk ). The IARC p53 website also provides reports on database analysis and links with other p53 sites as well as with related databases. In this report, we describe the criteria for inclusion of data, the revised format and the new visualisation tools. We also briefly discuss the relevance of p 53 mutations to clinical and biological questions.
Explore the source record for details and available documents.
From the time a decision was made to purchase an archive until a purchase order was issued took approximately 10 months. During this period an RFI was developed, issued and the results analyzed. Technical discussions were held and site visits were made. To ensure that current information was available, a complete review of available multi-modality DICOM compliant archives were made at the 1997 RSNA. With this information in-hand and the future development path for MICAS specified, a detailed RFQ was developed, responses were received and evaluated. A purchase order was to be issued by the end of the first quarter 1998. The archive vendor will have been selected by the time this paper appears in print. The oral presentation of this work will review the responses of the archive vendors and present the basis for selection. It is planned to publish our findings. The archive is the heart and brains of PACS. It controls information acquisition, distribution and storage plus work flow. It is critical that DICOM compliance and interoperability between all components of the PACS be an absolute requirement, especially for the archive.
OBJECTIVE: Noninvasive 24-hour ambulatory blood pressure monitoring holds great promise as a useful tool in the management of hypertensive pregnancies and pregnancies considered "at risk" for development of preeclampsia. The purpose of this study was to define ambulatory blood pressure monitoring parameters throughout normal pregnancy, including women considered at risk for development of hypertension who continued to have a completely normal pregnancy. STUDY DESIGN: Two hundred seventy-six 24-hour ambulatory blood pressure monitoring studies were made cross-sectionally with use of a Spacelabs 90207 device (validated for use in pregnancy), at one or more of 9 to 17, 18 to 22, 26 to 30, and >30 weeks' gestation. Upper limits of normal were defined as the mean plus 2 SDs for awake and sleep ambulatory blood pressure monitoring results at each stage. RESULTS: Average awake upper limits of normal were 130/77, 132/79, 133/81, and 135/86 mm Hg at the four stages of pregnancy, respectively. Systolic blood pressure fell significantly by 12% to 14% (p < 0.0001) and diastolic blood pressure by 18% to 19% (p < 0.0001) during sleep at all stages of pregnancy. Awake ambulatory blood pressure monitoring systolic measurements were 11 to 12 mm Hg higher than "clinic" measurements (p < 0.001) and diastolic measurements were 5 to 11 mm Hg higher (p < 0.0001) throughout pregnancy. Maximum blood pressure variability ranged from 8 to 13 mm Hg. CONCLUSIONS: The upper limits of normal ambulatory blood pressure monitoring-derived measurements rise slightly as pregnancy progresses. Awake measurements are higher than "clinic" measurements recorded under relaxed conditions by a clinical researcher. The diurnal blood pressure fall and variabilities are similar during pregnancy to those seen in nonpregnant subjects. These data should provide valuable references for further studies of ambulatory blood pressure monitoring in high risk pregnancies.