Coping with transition through organisation: Techiman Market, Ghana.
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Africa↗
Biomedical subjects
C Dennis
Publications and source records attributed to C Dennis.
Single lung transplantation for end stage emphysema.
BACKGROUND: The first successful single lung transplantation was carried out in 1983 for pulmonary fibrosis. Because of the inherent advantages of single lung transplantation, a transplantation programme has been started for patients with end stage lung disease due to emphysema. METHODS: Between October 1990 and August 1993 25 patients with severe emphysema (15 men, mean age 51 years) received a single lung transplant at our institution. All patients were severely disabled with a mean (SD) 12 minute walking distance of 281 (165) metres. There were five deaths in the series, four in the first 20 days and one on day 503. Two patients suffered graft compression by air trapping in the native lung. Bronchial narrowing requiring insertion of endobronchial stenting occurred in four patients. RESULTS: Mean (SD) FEV1 improved from a preoperative value of 17.8(13%) predicted to a six month value of 53.6(13)%, and FEV1/FVC from 23.8(12)% to 68.6(15)%. After the transplant 12 patients are in New York Heart Association (NYHA) class I and the rest of the survivors are in NYHA II. Actuarial survival was 82% at one year and 74% at three years. CONCLUSIONS: Single lung transplantation is an effective treatment for end stage lung disease due to emphysema and carries an acceptable mortality and morbidity.
Adult↗
Identifying nursing research priorities: general and neuroscience specific at an acute care hospital.
As a result of economic and health care changes the role of the nurse continues to expand and research-based practice is changing its focus. Limited resources and staff shortages have revealed new areas for research study. Clinical nurses have valuable questions to share that can form the basis of future nursing research. The purposes of the study were to: (a) Determine the priorities for nursing research within a single acute care teaching hospital; (b) Promote nurses' awareness of the importance of research-based practice; (c) Facilitate the development of future nursing research. It was assumed that nurses who carry out direct and indirect patient care roles are "experts" and therefore, are in a position to identify what they see as important questions and in need of further investigation. Three hundred and sixty-six nurses (24%) responded to round #1 of the open ended survey and submitted a total of 912 clinical practice issues. Initially, issues were broadly categorized into clinical and indirect clinical themes in a series of subcategories. Round #2 was conducted to identify nurses' ratings of the priority of the final 123 research issues for future clinical research and practice improvement efforts. Results of the two rounds will be presented, including issues identified by neuroscience nurses. This information will provide a valuable source for additional neuroscience research at either the local or international level.
Acute Disease↗
Isolation and genetic mapping of two novel members of the murine Wnt gene family, Wnt11 and Wnt12, and the mapping of Wnt5a and Wnt7a.
The murine Wnt genes are implicated in the control of a variety of developmental processes. Using a PCR-based approach, we have isolated two novel members of the murine Wnt gene family, Wnt11 and Wnt12. These cDNAs display an amino acid sequence identity of between 38 and 49% with all other murine Wnts over the regions that we have isolated. In addition, two previously described Wnt genes, Wnt5a and Wnt7a, were detected in RT-PCR products. Interspecific crosses were used to demonstrate close linkage between Wnt12 and Wnt1 on Chromosome (Chr) 15. Wnt7a was mapped to mouse Chr 6, Wnt5a to the centromeric region of Chr 14, and Wnt11 to Chr7.
Amino Acid Sequence↗
Expandable metal stents for tracheobronchial obstruction.
We report our experience of the use of endoscopically inserted expanding stainless steel stents in 18 patients over a period of 31 months. Twelve patients had stents inserted for malignant disease causing narrowing of the tracheobronchial tree, and six for airway complications following heart-lung, single lung or double lung transplantation. In all but one case, stents were satisfactorily positioned, and there were no complications related to stent insertion. Seven patients were alive at follow-up, three of whom had stents inserted for malignancy and four as a result of complications following transplantation.
Adult↗
[Radiological findings in lung transplantation].
Lung transplantation (single-lung transplantation, double-lung transplantation or heart-lung transplantation) may be the only effective therapy in end-stage pulmonary disease. At specialized institutions it has been performed on a routine basis for some years now. Diagnostic imaging plays an important role in the assessment of potential recipients as well as for the postoperative evaluation after transplantation. The aim of this review is to describe the role of imaging procedures of the chest in these patients and to demonstrate characteristic plain radiographic and computed tomographic findings. Normal postoperative findings specific to lung transplant patients as well as typical complications are presented. These include reimplantation response, acute and chronic rejection, and the typical bacterial, viral, and fungal infections as well as the sequelae of transbronchial biopsy.
Adult↗
Risk factors for survival following combined heart-lung transplantation. The first 100 patients.
As the numbers of heart and lung transplant recipients have increased it has become possible to identify major risk factors for early (within 3 months) and later (after 3 months) death after this procedure. For 100 patients receiving organs between April 1984 and February 1991, and followed up until February 1992, patient characteristics, operative details, and early morbidity were assessed for their effects on early and later deaths. Recipient age, sex, and preoperative diagnosis did not have a significant effect on early (within 3 months) or later death. Positive cytomegalovirus antibody status of donor or recipient conferred greater risk of death within 90 days (odds ratio [OR] = 3.24, P = 0.06). Greater than 2 L blood in the first 24 hr after operation (OR = 6.00, P = 0.05), and ventilation for greater than 24 hr (OR = 4.87, P = 0.006) were significant prognostic indicators of early death. After the first 3 months, the main risk factor for death was rejection in the first 3 months (OR = 1.38 per episode, P = 0.008). Early infection in general and CMV infection in particular were associated with a small increase in risk. This study confirms the importance of matching donor and recipient for CMV and shows that difficulties during operation, reflected in postoperative bleeding and ventilation times increased the chance of early death. Later death was associated with early acute rejection. A detrimental effect of infection, including CMV infection, either does not exist, or is too small to be detected in a study of this size.
Actuarial Analysis↗
Two novel microsatellite markers for prenatal prediction of spinal muscular atrophy (SMA).
Autosomal recessive spinal muscular atrophy (SMA) has been mapped to a 6-cM interval on chromosome 5q12-13.3, flanked proximally by locus D5S6 and distally by locus D5S112. In this study we describe the isolation of two new microsatellite markers (EF1/2a and EF13/14) near locus D5S125, which lies 2 cM distal to D5S6. We show by linkage analysis and the study of the recombinants in 55 SMA pedigrees that the disease lies in the 4-cM interval between EF1/2a and D5S112. Fluorescence in situ analysis of cosmids from D5S6, EF1/2 and D5S112 confirms the genetic order and relative distance of markers. The microsatellites EF1/2a and EF13/14 are the first highly polymorphic PCR-based proximal markers in SMA to be described, and will be of value in prenatal prediction of the disorder.
Base Sequence↗
Donor-transmitted bacterial infection in heart-lung transplantation.
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Adult↗
Heart-lung transplantation for end-stage respiratory disease in cystic fibrosis patients.
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Adolescent↗
Return to work after uncomplicated myocardial infarction: a trial of practice guidelines in the community.
OBJECTIVE: To evaluate the effectiveness of practice guidelines for return to work after acute myocardial infarction when disseminated from a university-based setting to a practice-based setting. DESIGN: Randomized clinical trial. PATIENTS: A total of 187 patients with uncomplicated acute myocardial infarction. INTERVENTION: Patients were randomly assigned to the intervention (n = 95) or to usual care (n = 92). The intervention consisted of a treadmill test, a counseling session based on the test results, and a consultation letter from a cardiologist to the primary care physician. Individualized recommendations for the timing of return to work, contained in the consultation letter, were based on the patient's risk for recurrent cardiac events. MEASUREMENTS: Questionnaire, chart review, and a phone interview documented the timing of return to work and the rates of cardiac death, coronary angioplasty, coronary artery surgery, and recurrent myocardial infarction. RESULTS: Median intervals between acute myocardial infarction and return to work were similar in both groups (intervention, 54 days; usual care, 67 days; P greater than 0.2). Among patients without myocardial ischemia, however, the interval was shorter in the intervention group than in the usual care group (38 days compared with 65 days, respectively, P = 0.008). Among patients with myocardial ischemia, intervals were similar in both groups (80 days compared with 76 days, respectively, P greater than 0.2). CONCLUSION: Practice guidelines developed in a university-based setting were not as successful in hastening return to work after uncomplicated acute myocardial infarction when tested in a practice-based setting. Physicians' reluctance to follow guidelines for patients with myocardial ischemia reflected their concern with prognosis even though medical outcome was good.
Adult↗
Effects of anger on left ventricular ejection fraction in coronary artery disease.
This study examined the comparative potency of several psychological stressors and exercise in eliciting myocardial ischemia as measured by left ventricular (LV) ejection fraction (EF) changes using radionuclide ventriculography. Twenty-seven subjects underwent both exercise (bicycle) and psychological stressors (mental arithmetic, recall of an incident that elicited anger, giving a short speech defending oneself against a charge of shoplifting) during which EF, blood pressure, heart rate and ST segment were measured. Eighteen subjects had 1-vessel coronary artery disease (CAD), defined by greater than 50% diameter stenosis in 1 artery as assessed by arteriography. Nine subjects served as healthy control subjects. Anger recall reduced EF more than exercise and the other psychological stressors (overall F [3.51] = 2.87, p = .05). Respective changes in EF for the CAD patients were -5% during anger recall, +2% during exercise, 0% during mental arithmetic and 0% during the speech stressor. More patients with CAD had significant reduction in EF (greater than or equal to 7%) during anger (7 of 18) than during exercise (4 of 18). The difference in EF change between patients with CAD and healthy control subjects was significant for both anger (t25 = 2.23, p = 0.04) and exercise (t25 = 2.63, p = 0.01) stressors. In this group of patients with CAD, anger appeared to be a particularly potent psychological stressor.
Anger↗
Coronary flow reserve is impaired early after cardiac transplantation.
The highest mortality rate after cardiac transplantation, at present, occurs within the first year after cardiac transplantation. The state of the coronary microcirculation soon after cardiac transplantation has not been previously assessed. We investigated the hypothesis that coronary flow reserve (CFR) is impaired in the early postoperative period after cardiac transplantation. A 3F intracoronary Doppler flow probe was inserted into the left anterior descending coronary artery and maximal coronary flow was assessed using the non-endothelial-dependent vasodilator papaverine. We compared two groups of patients: group A--13 patients studied 3 months after operation; and group B--25 patients studied at a median of 4 years after operation (range 2-8 years) without coronary occlusive disease (COD). CFR was defined as the quotient of maximum hyperaemic to resting velocity (vel). CFR was markedly impaired in group A patients compared with group B (3.3 SEM 0.3 versus 4.2 SEM 0.2, P < 0.01). No significant differences between mean resting or peak velocities, original diagnosis, age, active rejection, blood pressure, lipid levels, ischaemic time, cyclosporin levels or cytomegalovirus (CMV) status were noted. Responses to papaverine in resistance coronary vessels are impaired in the early postoperative period after cardiac transplantation. This is caused by a combination of higher resting flow and lower peak flow in the early group. This impairment of function in the coronary microcirculation may contribute to early graft dysfunction and reflect changes in vascular smooth muscle function leading to the development of COD.
Adult↗
Coronary flow reserve and coronary occlusive disease.
The functional effects of coronary occlusive disease (COD) in cardiac transplant patients on small-resistance coronary vessels are unclear. We investigated the changes in coronary flow reserve (CFR) in response to the non-specific smooth muscle vasodilator papaverine. A 3F Doppler probe was inserted into the left anterior descending (LAD) coronary artery in 61 patients following orthotopic heart transplantation. Studies were performed in 57 males and 4 females with a mean age of 46 years (range 20-61 years). The median time from operation was 4 years (range 3 months to 10 years). Coronary blood velocity was measured at rest (RFV) and maximum hyperaemia (PFV) produced by intracoronary papaverine. Coronary flow reserve (CFR) was defined as the ratio of PFV to RFV. Minor lesions in epicardial vessels were found in 23 transplant patients. The mean percentage diameter of the most severe lesion in the coronary tree was 23% SD 3% including 12 lesions in the LAD coronary artery itself (mean 24% SD 4%). Patients with COD had an impaired CFR (2.6 SEM 0.2) compared with normals (3.9 SEM 0.2, P = 0.0003), adjusting for year after operation. Mean resting flow velocity was similar in both groups (minor COD, 6.8 cm/s SEM 1.2; normals, 7.1 cm/s SEM 0.6), but mean peak flow velocity response to papverine was reduced (16.5 cm/s SEM 2.5 versus 27.3 cm/s SEM 2.6; P = 0.007). In the presence of minor epicardial disease, coronary flow reserve in resistance vessels was reduced due to impairment of peak flow. This demonstrates that non-endothelial-dependent coronary resistance vessel vasodilatation is abnormal and may be caused by a defect in vascular smooth muscle function.
Blood Pressure↗
Initiation and execution of movement sequences in those suffering from and at-risk of developing Huntington's disease.
Recent research has shown that Huntington's disease (HD) causes problems in the initiation and execution of movement (akinesia, bradykinesia): information which is useful in documenting the functional progression of the disease. The present experiment used a sequential movement task to characterize such impairments. Eighteen patients diagnosed as suffering from HD, and a similar number of matched At-Risk (AR) and Normal control subjects, performed sequential button pressing tasks, under varying amounts of visual advance information. Specific dimensions of motor control were examined (hand, direction). Movement initiation and in particular movement duration were useful indicators of the functional progression of the disease, and also detected anomalies of performance in some AR individuals. Impaired motor programming was indicated by patients' difficulty in initiating movements in the absence of external visual cues, and their problems in utilizing advance information to control movement. Patients had specific deficits in initiating movements with the nonpreferred hand, and directional movement asymmetries were accentuated. The results suggest that HD causes difficulties at three discrete levels: in utilizing advance information, in the initiation and in the spatial representation of movement.
Adult↗
Failure of an Ohmeda OAV 7750 ventilator.
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Equipment Failure↗
Cardiac rehabilitation. Current status and future directions.
Comprehensive cardiac rehabilitation is more than exercise training for patients with coronary artery disease and now includes all aspects of secondary prevention. Exercise training is individually prescribed based on clinical status and therapeutic goals. Smoking cessation and abstinence and the treatment of hypercholesterolemia are integral to the rehabilitation process. Education and counseling are important adjuncts to treatment, especially soon after a coronary event. Vocational rehabilitation can be included simply and effectively in the rehabilitation process. Efficient and cost-effective cardiac rehabilitation is tailored to a patient's medical condition, risk factor evaluation, and vocational status. The future of cardiac rehabilitation will be linked to the success of training nonphysician health professionals to provide preventive services.
Ambulatory Care↗
Vaginal antibody of patients with trichomoniasis is to a prominent surface immunogen of Trichomonas vaginalis.
Twenty vaginal washes (VWs) and ten vaginal mucus (VM) samples from patients with trichomoniasis were examined for the presence of antibody to surface protein immunogens of Trichomonas vaginalis. Fourteen of 20 VWs (70%) and 8 of 10 VM (80%) had immunoglobulin G (IgG) antibody (Ab) that reacted in an immunoprecipitation (IP) assay with one iodinated Trichomonas vaginalis surface protein immunogen with a relative molecular mass of 230,000 daltons (230-kDa) (P230). No similar IP of any iodinated protein was observed when detergent extract was first depleted of P230 with monoclonal antibody (MAb), indicating a highly specific VW IgG response of patients to P230. VWs were also obtained from 10 patients from one to four weeks after treatment. These VWs had the same, or in one case a greater, level of IgG to P230. Under no circumstances was Ab to P230 or any other trichomonad protein detected in VWs or VM from normal, uninfected women. Flow cytofluorometry with VW Ab yielded heterogeneous fluorescent and non-fluorescent populations of trichomonads, reaffirming the restricted Ab response to one or a few epitopes on P230 in the vagina of patients. Under identical conditions, the MAb gave totally fluorescent parasite populations of some isolates, and the MAb again demonstrated variable epitope accessibility to Ab binding (Infect Immun 1987;55:1037). Finally, the MAb or VW Ab was never cytolytic for immunoreactive (fluorescent) parasites, even in the presence of complement. This study identifies the most important trichomonad surface immunogen on the basis of the vaginal Ab response, and data underscore the significance of immune evasion strategies of this sexually transmitted disease agent.
Animals↗