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Biomedical subjects

B Black

Publications and source records attributed to B Black.

At least 19 recordsLinked to original sources
PubMed1998

Heat shock treatment releases Penicillium phosphoglycopeptide.

Filtrates of heat (54 degrees) treated day-5 Penicillium fellutanum cultures contained 70 mg of peptidophosphogalactomannan-II; an unheated control contained 30 mg. The polymer contained up to 60 phosphodiesters, and 5-O-beta-D-galactofuranosyl, mannopyranosyl, amino acyl and 2-aminoethanol residues. Its 13C NMR spectrum was nearly identical with that of the control polymer. The major 31P NMR signal was phosphocholine phosphodiester at delta 0.22 ppm: significant phosphodiester signals occurred at delta 1.15, 1.33 and 1.47. Dilute mineral acid released galactofuranosyl residues from the mannan. Signals at delta 1.15-1.47 ppm were associated with molecules of mass less than 3500 and contained galactose, 2-aminoethanol and peptide(s). After this acid treatment, signals at delta 1.0-0.22 remained associated with the mannan. Heat released up to 4-fold more of peptidophosphogalactomannan-III compared with the untreated control; carbohydrate and phosphate content, per mg polymer, were reduced by 4- and 2-fold, respectively. A galactofuranosyl-, phosphoryl- and amino acyl-containing polymer of Mr greater than 14,000 was solubilized by alkali treatment of P. fellutanum cell walls.

Carbohydrate Sequence↗
PubMed1998

Treating tuberculosis: the essential role of social work.

The resurgence of tuberculosis gives cause for alarm. Compliance with an effective medication regimen leads to cure; yet, many patients fail to comply. This paper discusses factors affecting compliance and the essential role of social work, from an ecological perspective, when intervening to increase compliance. The authors relate comments made by patients at the only hospital originally and still serving as a TB sanatorium in relation to literature on compliance. Changes at the hospital include the development of a social work department which uses the ecological perspective in working with patients whose histories include non-compliance, as well as alcoholism, homelessness, loneliness, joblessness, and AIDS. The content of interviews with patients reveal and identify problems for future research.

Florida↗
PubMed1998

The use of vascular flaps in middle ear surgery.

OBJECTIVE: This study aimed to evaluate improved surgical outcomes from middle and external ear surgery using local vascular flaps to enhance tissue healing. STUDY DESIGN: The study design was a review of the design and clinical trials of three soft tissue flaps: the middle temporal flap (MTF), the middle temporal canal flap (MTCF), and the wing flap. All derive axial vascular supply from the middle temporal vessels. SETTING: The study was performed at a single surgeon's private otologic practice. PATIENTS: A total of 319 patients were treated from 1991-1996: MTF in 223, MTCF in 38, and wing flap in 58. The average case maturity was 2.25 years. Most cases were mastoidectomy reconstruction or intact canal wall mastoidectomy. INTERVENTION: The flaps are used to introduce an improved blood supply to key repair sites in the middle and external ear. MAIN OUTCOME MEASURES: Canal skin breakdown, chronic myringitis, and chronic otitis externa were measured. RESULTS: Dehiscence rates fell from 15-5% and myringitis rates fell from 15-4%. Thicker, vascular canal skin was the usual result. CONCLUSIONS: The flaps provide the optimal method of revascularizing the external canal during mastoidectomy reconstructions and possibly canal defect repairs during intact canal wall mastoidectomy. Further studies are required to evaluate the efficacy of the wing flap and the MTCF.

Ear, Middle↗
PubMed1998

Mastoidectomy elimination: obliterate, reconstruct, or ablate?

OBJECTIVE: This study aimed to evaluate a chronology of techniques used to manage troublesome open mastoid cavities, with emphasis on the selection of the mastoidectomy elimination technique most appropriate to the case at hand. STUDY DESIGN: The study design was a retrospective review of techniques used in 465 consecutive elimination cases. SETTING: The study was conducted at a single surgeon's private otologic practice. PATIENTS: Patients with mastoidectomy elimination who were treated from 1974-1996, including 55 patients with obliterations (cavity fill-in), 372 patients with reconstructions (canal wall repair), and 38 patients with ablations (external canal closure), requiring 823 procedures, were examined. MAIN OUTCOME MEASURES: Clinical success and complication rates of the techniques studied were measured. RESULTS: Optimal outcomes (89% successful) were recorded from hydroxylapatite reconstruction cases managed with canal revascularization (middle temporal flap) and cholesteatoma prevention (staging and composite grafts). CONCLUSIONS: Obliteration is recommended only over noncholesteatomatous sites because of the risk of residual disease and the difficulty re-exploring these cases. Ablation is effective in selected, severely damaged cases. All ablation cases remained disease-free after surgery. Reconstruction is the preferred method when hearing restoration is required. Canal wall reconstruction required modifications to avoid complications from poor tissue vitality and cholesteatoma. These are outlined and discussed below.

Cartilage↗
PubMed1997

Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia.

BACKGROUND: Idiopathic orthostatic tachycardia (IOT) is characterized by an increase in heart rate (HR) with standing of > or = 30 bpm that is associated with elevated catecholamine levels and orthostatic symptoms. A dynamic orthostatic hypovolemia and alpha1-adrenoreceptor hypersensitivity have been demonstrated in IOT patients. There is evidence of an autonomic neuropathy affecting the lower-extremity blood vessels. METHODS AND RESULTS: We studied the effects of placebo, the alpha1-adrenoreceptor agonist midodrine (5 to 10 mg), the alpha2-adrenoreceptor agonist clonidine (0.1 mg), and I.V. saline (1 L) in 13 patients with IOT. Supine and upright blood pressure (BP) and HR were measured before and at 1 and 2 hours after intervention. Midodrine decreased both supine and upright HR (all HR values are given as bpm) at 2 hours (from 78+/-2 supine to 108+/-5 upright before treatment and from 69+/-2 supine to 95+/-5 upright after treatment, P<.005 for supine and P<.01 for upright). Saline decreased both supine and upright HR (from 80+/-3 supine to 112+/-5 upright before infusion and from 77+/-3 supine to 91+/-3 upright 1 hour after infusion, P<.005 for supine and P<.001 for upright). Clonidine decreased supine HR (from 78+/-2 to 74+/-2, P<.03) but did not affect the HR increase with standing. Clonidine very significantly decreased supine systolic BP (from 109+/-3 at baseline to 99+/-2 mm Hg at 2 hours, P<.001), and midodrine decreased supine systolic BP mildly. CONCLUSIONS: IOT responds best acutely to saline infusion to correct the underlying hypovolemia. Chronically, this can be accomplished with increased salt and water intake in conjunction with fludrocortisone. The response of patients to the alpha1-agonist midodrine supports the hypothesis of partial dysautonomia and indicates that the use of alpha1-agonists to pharmacologically replace lower-extremity postganglionic sympathetics is an appropriate overall goal of therapy. These findings are consistent with our hypothesis that the tachycardia and elevated catecholamine levels associated with IOT are principally due to hypovolemia and loss of adequate lower-extremity vascular tone.

Adolescent↗
PubMed1997

Driver fatigue in the city.

The current survey investigates the features of driver fatigue incidents (accidents, near accidents and unintentional drifting-out-of-lane events) which occurred in cities. The results show similar patterns to previous surveys, with incident trips tending to be short, and prior sleep loss and late night driving featuring as factors. Work trips feature very strongly among city fatigue incident trips and work is also a common reason for sleep loss before a fatigue incident. Consistent with the high representation of work trips, there are peaks in incident occurrence at commuter travel times. Shiftworkers are prominent amongst fatigue incident-involved drivers. Social trips also feature amongst fatigue incident trips but are likely to be more difficult to address with countermeasures.

Accidents, Occupational↗
PubMed1997

Differentiating recruitment strategies for direct patient care, clerical, and fundraising hospice volunteers.

A survey of direct patient care and nondirect patient care volunteers in two hospice programs generated information about various aspects of their volunteer experience. This paper focuses on the effectiveness of identified recruitment strategies for direct patient care, clerical, and fundraising volunteers. People learned about the opportunity to volunteer at hospice most frequently from personal experiences, friends, and newspapers. Significantly more direct patient care volunteers learned about the volunteer opportunity through newspaper feature stories than did nondirect volunteers. Friends recruited significantly more fundraising volunteers than direct patient care or clerical volunteers. The events triggering direct care and clerical volunteers to serve were most often personal experiences, whereas friends appear to have triggered direct care and fundraising volunteers to serve.

Aged↗
PubMed1996

The prevalence of psychiatric disorders in elderly residents of public housing.

BACKGROUND: This study estimates lifetime and one-month prevalence of psychiatric disorders among elderly public housing residents. METHOD: Nine hundred forty-five residents of six public housing developments for the elderly were administered the General Health Questionnaire (GHQ), the Mini-Mental State Examination (MMSE), and the CAGE by lay interviewers. Residents screening positive and a 10% random sample of screen negatives were administered the Structured Clinical Interview for DSM-III-R (SCID) and a DSM-III-R derived algorithm for dementia and delirium. Prevalence rates were estimated based on weighted data from 298 subjects. RESULTS: Thirty-six percent of participants screened positive on at least one instrument. Based on the case identification interview, estimated lifetime prevalence of psychiatric disorders was 57.6%, and one-month prevalence was 27.9%. Cognitive disorder (10.5%), mood disorder (8.0%), psychotic disorder (4.6%), and substance abuse/dependence (4.4%) were the most common current disorders. Mood disorders (26.6%) and substance abuse/dependence (23.0%) were the most prevalent lifetime disorders. Compared to data from the Epidemiologic Catchment Area, public housing residents have higher current rates of mood disorder, schizophrenia, and substance use disorder. CONCLUSIONS: Elderly residents of public housing suffer higher rates of psychiatric morbidity than older people living independently in the community. The high prevalence of psychiatric disorders in this growing population of low-income elderly presents a challenge to the delivery of mental health service.

Aged↗
PubMed1996

The deep branch of the ulnar nerve in Guyon's canal: branching and innervation of the hypothenar muscles.

Thirty-seven embalmed, unpaired cadaver hands were dissected to delineate and classify the innervation of the hypothenar musculature. The deep branch of the ulnar nerve passed between the abductor digiti minimi and flexor digiti minimi and then pierced the opponens in all specimens. All branching occurred on the ulnar aspect of the deep branch of the ulnar nerve. A classification based on proximity of the different branches is prepared. Five different patterns have been noted.

Cadaver↗
PubMed1995

Psychiatric characteristics of children with selective mutism: a pilot study.

OBJECTIVE: To ascertain characteristics of children with selective mutism. METHOD: Subjects with selective mutism were evaluated by means of parent and teacher rating scales and structured diagnostic interviews. RESULTS: Thirty children were evaluated. Mutism severity varied markedly in different environmental settings. Ninety-seven percent of the subjects were diagnosed with social phobia or avoidant disorder of childhood or adolescence or both and 30% with simple phobia. No other psychiatric disorders were common. Parent and teacher rating scales showed high levels of anxiety symptoms, especially social anxiety, and low levels of all other psychiatric symptoms. Anxiety and social anxiety severity correlated with mutism severity. First-degree family history of social phobia and of selective mutism, obtained by family history method, was present in 70% and 37% of families, respectively. There was no evidence of a causal relationship between psychologically or physically traumatic experiences and development of selective mutism. CONCLUSIONS: Selective mutism may be a symptom of social anxiety, rather than a distinct diagnostic syndrome. Further study of the characteristics of children with selective mutism and their families is warranted.

Adolescent↗
PubMed1995

Anxiety disorders in children and adolescents.

Anxiety disorders are common in children and adolescents and may be associated with significant suffering, disruptions of normal psychosocial and academic development, disruption of family functioning, and increased utilization of medical services. They are frequently chronic disorders. Effective early interventions for children and adolescents with anxiety disorders may reduce or eliminate potentially life-long suffering and impairment.

Adolescent↗
PubMed1995

Mastoidectomy elimination.

Surgery that eliminates the open radical cavity takes three forms: obliteration (cavity fill-in, reconstruction (canal wall defect repair), or ablation (external canal closure). The evolution of each variety is reviewed in detail and a personal series of 240 cases is discussed. These included obliterations and reconstructions employing porous hydroxylapatite ceramic implants. Larger defects required Grote implants, but high facial ridge cases were managed with attic defect plates and limited canalplasty. Canal repair success rates improved with the use of the middle temporal flap to improve canal wall vascularity Residual cholesteatoma has been prevented by staged surgery, and recurrent disease has been virtually abolished by aggressive prevention techniques which employ drum reinforcement with finely shaven cartilage-perichondrium composite grafts. Ossiculoplasty procedures included 85 Plastipore columellas, 107 Oval-Top hydroxylapatite/Teflon columellas and, more recently, 17 Spanner malleus-stapes/footplate assemblies. Earlier poor results have been succeeded by more satisfactory levels. Since 1990, the air-bone gap has been closed to within 10 dB in 33% of cases and to within 20 dB in 66% of cases. Studies using SPITE (surgical, prosthetic, infection, tissues, and eustachian) adverse indicators have demonstrated high levels of pathology in elimination cases, when compared with nonelimination series. The SPITE studies have also demonstrated the reduction of pathology levels by staged surgery. Elimination surgery now provides permanent relief from the problem cavity in all but a few cases.

Bone Plates↗
PubMed1994

Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study.

OBJECTIVE: To evaluate the efficacy of treatment with fluoxetine in reducing symptoms associated with elective mutism. METHOD: Sixteen subjects with elective mutism were treated with placebo (single-blind) for 2 weeks. Fifteen placebo nonresponders were then randomly assigned to double-blind treatment with fluoxetine at a dose of 0.6 mg/kg/day (N = 6) or continued placebo (N = 9) for an additional 12 weeks. Outcome ratings were completed by the treating psychiatrist, parents, and teachers. RESULTS: Significant improvements over time on ratings of elective mutism, anxiety, and social anxiety, rated by clinician, parents, and teachers, were demonstrated in both fluoxetine- and placebo-treated subjects. Subjects treated with fluoxetine were significantly more improved than placebo-treated subjects on parent's ratings of mutism change and global change. Clinician and teacher ratings did not reveal significant differences between treatment groups. Although improved, most subjects in both treatment groups remained very symptomatic at the end of the study period. Side effects were minimal. CONCLUSION: Fluoxetine may be beneficial and safe in the treatment of children with elective mutism. Longer periods of treatment may yield more substantial therapeutic benefits. Further study is indicated.

Adolescent↗
PubMed1994

Spanner malleus-stapes/footplate assembly.

A simply prepared and implanted ossiculoplasty prosthesis is described for use when the malleus is suited to assembly procedures. The one versatile hydroxylapatite and Teflon model is suitable for both the malleus-stapes and malleus-footplate role. Clinical trials of 80 prostheses in place for 5 to 18 months have confirmed excellent surgical handling properties combined with optimal audiological results.

Ear Ossicles↗
PubMed1994

Mastoidectomy reconstruction: revascularizing the canal wall repair.

Blood supply is the key to reconstruction of canal wall defects in cases of prior radical mastoidectomy. Revascularization of the defect is essential to nourish the overlying canal skin and to protect and supply the underlying solid support layer. Prior techniques have relied on free grafts or on local flaps of suspect vascular adequacy. A temporal pericranial flap is described that introduces a vascular bundle directly into the canal wall defect site. The flap is based on the superior and posterior aspects of the pinna and contains the middle temporal artery, which provides axial supply to the flap tip. The tissues of the flap are compact, enabling easy handling in the confines of the new canal. The flap is turned medially into the canal, avoiding compression or kinking of the vascular axis. The technique has been used in over 60 cases, producing excellent clinical results from a simplified technique.

Child, Preschool↗