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Biomedical subjects

C Mann

Publications and source records attributed to C Mann.

At least 37 records · Page 2Linked to original sources
PubMed2000

Age and sex differences in presentation of symptoms among patients with acute coronary disease: the REACT Trial. Rapid Early Action for Coronary Treatment.

BACKGROUND: There are few data on possible age and sex differences in presentation of symptoms for patients with acute coronary disease. OBJECTIVE: To investigate demographic differences in presentation of symptoms at the time of hospital presentation for acute myocardial infarction (AMI) and unstable angina. METHODS: The medical records of patients who presented with chest pain and who also had diagnoses of AMI (n = 889) or unstable angina (n = 893) on discharge from 43 hospitals were reviewed as part of data collection activities of the Rapid Early Action for Coronary Treatment trial based in 10 pair-matched communities throughout the USA. RESULTS: Dyspnea (49%), arm pain (46%), sweating (35%), and nausea (33%) were commonly reported by men and women of all ages in addition to the presenting complaint of chest pain. After we had controlled for various characteristics through regression modeling, older persons with AMI were significantly less likely than were younger persons to complain of arm pain and sweating, and men were significantly less likely to report vomiting than were women. Among persons with unstable angina, arm pain and sweating were reported significantly less often by elderly patients. Nausea and back, neck, and jaw pain were more common complaints of women. CONCLUSIONS: Results of this study suggest that there are differences between symptoms at presentation of men and women, and those in various age groups, hospitalized with acute coronary disease. Clinicians should be aware of these differences when diagnosing and managing patients suspected to have coronary heart disease.

Adult↗
PubMed2000

The emergency department experience of chest pain patients and their intention to delay care seeking for acute myocardial infarction.

This study investigated how patients' emergency department experience was related to their intention to delay action in response to future symptoms of acute myocardial infarction. A sample of 426 persons admitted to the emergency department with a chief complaint of chest pain and released from the emergency department were contacted by telephone. Patients were queried about their affective response to the emergency department experience, their satisfaction with emergency department staff communication, their intention to delay prompt action for acute myocardial infarction symptoms in the future, the influence of others in the decision to seek care, and medical and demographic status. The results of a mixed model linear regression analysis showed that the less education patients had (p = 0.007), the less sure they felt that going to the emergency department had been "the right thing to do" (p = 0.004), and the greater the degree of embarrassment (p = 0.0001), the greater was the intention to delay action for future symptoms of acute myocardial infarction. The results also showed that those patients who were prompted by health professionals to go to the emergency department were less likely to report intentions to delay for future symptoms (p = 0.036). It is important that emergency department staff reassure chest pain patients who are sent home that they did the right thing by coming to the emergency department for their symptoms. Providers need to be particularly sensitive to feelings of embarrassment.

Chest Pain↗
PubMed2000

Regulation of cytokinesis by the Elm1 protein kinase in Saccharomyces cerevisiae.

A Saccharomyces cerevisiae mutant unable to grow in a cdc28-1N background was isolated and shown to be affected in the ELM1 gene. Elm1 is a protein kinase, thought to be a negative regulator of pseudo-hyphal growth. We show that Cdc11, one of the septins, is delocalised in the mutant, indicating that septin localisation is partly controlled by Elm1. Moreover, we show that cytokinesis is delayed in an elm1delta mutant. Elm1 levels peak at the end of the cell cycle and Elm1 is localised at the bud neck in a septin-dependent fashion from bud emergence until the completion of anaphase, at about the time of cell division. Genetic and biochemical evidence suggest that Elm1 and the three other septin-localised protein kinases, Hsl1, Gin4 and Kcc4, work in parallel pathways to regulate septin behaviour and cytokinesis. In addition, the elm1delta;) morphological defects can be suppressed by deletion of the SWE1 gene, but not the cytokinesis defect nor the septin mislocalisation. Our results indicate that cytokinesis in budding yeast is regulated by Elm1.

Cell Cycle Proteins↗
PubMed2000

A case-control auditory evaluation of patients treated with artemisinin derivatives for multidrug-resistant Plasmodium falciparum malaria.

The artemisinin derivatives are now used widely in areas with multidrug-resistant Plasmodium falciparum malaria such as Southeast Asia, but concerns remain over their potential for neurotoxicity. Mice, rats, dogs, and monkeys treated with high doses of intramuscular artemether or arteether develop an unusual pattern of focal damage to brain stem nuclei (particularly those involved in auditory processing). To investigate whether a similar toxic effect occurs in patients treated with these compounds, clinical neurologic evaluation, audiometry and early latency auditory evoked responses were measured in a single-blind comparison of 79 patients who had been treated with > or =2 courses of oral artemether or artesunate within the previous 3 years, and 79 age- and sex-matched controls living in a malaria-endemic area on the northwestern border of Thailand. There were no consistent differences in any of these test results between the cases and controls. This study failed to detect any evidence of significant neurotoxicity in patients treated previously with oral artemether or artesunate for acute malaria.

Adolescent↗
PubMed2000

Tractional force generation by porcine Müller cells: paracrine stimulation by retinal pigment epithelium.

PURPOSE: To examine the ability of retinal pigment epithelial (RPE) cells to modulate Müller cell extracellular matrix contraction through secreted promoters. METHODS: Freshly isolated RPE cells were maintained in continuous culture until the morphologic and immunocytochemical changes associated with myofibroblastic dedifferentiation were complete. Secretory products collected from these cells during extended incubations in serum-free medium and at different stages of dedifferentiation were examined for the ability to promote extracellular matrix contraction by Müller cells. The contributions of specific growth factors to RPE-secreted activity were examined with growth factor-neutralizing antibodies. RESULTS: Secretory products from RPE cells throughout dedifferentiation contained biologically active quantities of Müller cell contraction promoters. Secretory activity increased during extended incubation in serum-free medium and during myofibroblastic dedifferentiation. Growth factor-specific neutralizing antibodies enabled the determination that insulin-like growth factor- and platelet-derived growth factor-related proteins were the secreted species to which Müller cells responded. Finally, gene expression of insulin-like growth factor 1 and platelet-derived growth factor A chain by porcine RPE cells was confirmed using reverse transcription-polymerase chain reaction. CONCLUSIONS. RPE cells are a viable source of biologically active quantities of two growth factors that stimulate extracellular matrix contraction by Müller cells. This secretory profile persists for extended periods in an otherwise serum-free environment and is enhanced during myofibroblastic dedifferentiation.

Animals↗
PubMed2000

The history of thoracic surgical instruments and instrumentation.

Thoracic surgical practice has evolved from the innovations of its pioneers. Beginning with the stethoscope discovered by Laënnec with his system of auscultation, to the tools we use in the dissection and control of the hilum of the lung for resection, our practice of thoracic surgery has been entwined with the development of instruments and instrumentation. The development of strategies to prevent death from the open pneumothorax began with manual control of the mediastinum and progressed through differential pressure to, finally, the technique of intubation and the methods of positive-pressure and insufflation anesthesia. The instruments we place in our hands are not enough to define our art. Entry into the chest would not be possible without the use of rib retractors, rib shears, and even periosteal elevators. Finally, to the present day of minimally invasive techniques and the application of thoracoscopy for therapeutic purposes, we find the efforts of our predecessors well developed. For the progression from the fear of the open pneumothorax to the present-day state of the ease of thoracotomy for lung resection we are indebted to those who gave so much of their time and, for some, their lives to death from tuberculosis, to allow the advancement of our practice of surgery. These great people should be remembered not only for their acceptance of novel ideas but also, more importantly, for their lack of fear of testing them.

Endoscopes↗
PubMed1999

Interleukin-10 (IL10) promoter polymorphisms and multiple sclerosis.

Interleukin-10 (IL10) is an anti-inflammatory cytokine which may modulate disease expression in multiple sclerosis (MS). Three dimorphic polymorphisms within the IL10 promoter region at positions - 1082, -819 and -519 have previously been identified. The - 1082*A allele has been associated with low and the - 1082*G allele with high in vitro IL10 production. We have genotyped 185 Caucasian MS patients and 211 ethnically matched controls for each of these three dimorphisms. MS patients were stratified for severity of disease outcome. No associations were found for any IL10 promoter polymorphisms when the MS cases were compared with controls or with disease outcome with regards to disability. IL10 polymorphism does not appear to be associated with MS or to influence disease progression.

Adult↗
PubMed1999

[Hemodynamic monitoring using esophageal Doppler ultrasonography during laparoscopic cholecystectomy].

PURPOSE: To evaluate the use of a 4-mHz continuous wave esophageal Doppler monitor in the hemodynamic management of 48 ASA I to III patients undergoing laparoscopic cholecystectomy. METHODS: General anesthesia was induced with fentanyl and propofol, maintained with N20 N20/02 and muscle relaxation was provided with atracurium. The lungs were mechanically ventilated. Non invasive arterial blood pressure, heart rate, capnography, arterial blood gas were monitored during CO2 pneumoperitoneum at 15-mmHg. Using the velocity waveform of descending aortic blood flow, the Doppler device estimated changes in cardiac output and systemic vascular resistances. RESULTS: Peritoneal insufflation resulted in a mean 19% decrease in cardiac output (range -49 to +5%; P < 0.05) and a mean 48% increased in systemic vascular resistances (range -7 to +101%; P < 0.01). There was no relationship between changes in cardiac output and mean arterial pressure or PETCO2. The esophageal Doppler provided, in two patients, details of hypertensive peaks (mean arterial pressure > 140 mmHg) which responded to administration of nicardipine. CONCLUSION: The Esophageal Doppler provided an easy-to-handle and non invasive tool to monitor changes in cardiac output during laparoscopic cholecystectomy. However, further comparison with a thermodilution cardiac output technique is required.

Adult↗
PubMed1999

Laparoscopic management of ectopic pregnancy.

The incidence of ectopic pregnancy has been rising over the last 20 years. The cause is multifactorial. The technical advancement in the field of minimal access surgery has greatly enhanced the possibility of both diagnosing and treating the condition effectively. The management of ectopic pregnancy can be expectant and surgical; the latter can be by open or laparoscopic methods. Laparoscopic surgery is usually performed when the patient is haemodynamically stable, the hCG is <6000 IU/L, the history is suggestive of minimal pelvic adhesions and when the pregnancy is confined within the tube. This procedure is, however, vastly dependent on the experience and expertise of the surgeon and the equipment facilities available. There are various means of treating ectopic pregnancy by laparoscopy. This includes laparoscopic salpingectomy, salpingotomy, and direct injection of cytotoxic agents. This article will present an overview to ascertain the effectiveness of minimal access surgery in managing ectopic pregnancy. There seems little doubt that laparoscopic management should be the first line of treatment. The way to realize its full potential is by formulating clear guidelines regarding the indication and implementation of laparoscopic surgery and emphasising the role of a fully structured training program to achieve the goals.

Female↗
PubMed1999

Saccharomyces cerevisiae MPS2 encodes a membrane protein localized at the spindle pole body and the nuclear envelope.

The MPS2 (monopolar spindle two) gene is one of several genes required for the proper execution of spindle pole body (SPB) duplication in the budding yeast Saccharomyces cerevisiae (). We report here that the MPS2 gene encodes an essential 44-kDa protein with two putative coiled-coil regions and a hydrophobic sequence. Although MPS2 is required for normal mitotic growth, some null strains can survive; these survivors exhibit slow growth and abnormal ploidy. The MPS2 protein was tagged with nine copies of the myc epitope, and biochemical fractionation experiments show that it is an integral membrane protein. Visualization of a green fluorescent protein (GFP) Mps2p fusion protein in living cells and indirect immunofluorescence microscopy of 9xmyc-Mps2p revealed a perinuclear localization with one or two brighter foci of staining corresponding to the SPB. Additionally, immunoelectron microscopy shows that GFP-Mps2p localizes to the SPB. Our analysis suggests that Mps2p is required as a component of the SPB for insertion of the nascent SPB into the nuclear envelope.

Adenosine Triphosphatases↗
PubMed1999

The relationship among carbon dioxide pneumoperitoneum, vasopressin release, and hemodynamic changes.

UNLABELLED: We assessed the role of vasopressin (VP) for the hemodynamic response to pneumoperitoneum in pigs. Four groups of anesthetized pigs were investigated. Nine pigs were intraabdominally insufflated with CO2 and eight were intraabdominally insufflated with argon; eight pigs received an i.v. injection of 1 mg/kg SR 49059, a VP antagonist, before CO2 insufflation; and six pigs received SR 49059 alone. Hemodynamics, plasma concentrations of VP and vasoactive hormones, and Paco2 were measured. Data were analyzed by using analysis of variance, Student's t-test, and Mann-Whitney U-test. Five minutes after insufflation, changes in systemic vascular resistance (SVR) were significantly correlated with changes in VP (r = 0.72; P = 0.005) but not with changes in epinephrine, norepinephrine, renin activity, or Paco2. SVR increased during CO2 insufflation but not during argon insufflation or CO2 insufflation with a preceding infusion of SR 49059. The SR 49059 injection itself resulted in increases in heart rate and cardiac output and decreases in blood pressure and SVR. We conclude that, during CO2 pneumoperitoneum in pigs, absorbed CO2 initiates a pathophysiological process that stimulates VP release. Hence, VP most likely plays a key role in the hemodynamic response to a CO2-induced pneumoperitoneum. IMPLICATIONS: Intraabdominal insufflation of CO2 is associated with hemodynamic and hormonal changes. Investigating CO2 and argon-insufflated pigs and using a vasopressin antagonist, we found that CO2 insufflation released vasopressin, which, in turn, induced hemodynamic perturbances.

Animals↗
PubMed1998

[Ambulatory surgery in French public hospitals. Present and future. "Public hospitals" group of the French Association of Ambulatory Surgery].

OBJECTIVES: To assess ambulatory surgery practices in France, make an inventory of projects for the creation of ambulatory structures and analyze the perception of different hospital personnel of ambulatory surgery. METHODS: A questionnaire was sent to 541 public hospitals with a surgery unit in France. The first part of the questionnaire was used to record current activity and existing projects for ambulatory surgery. The questionnaire also collected opinions concerning the analysis of difficulties encountered and possibilities offered by ambulatory surgery. RESULTS: Overall participation rate was 59%. Ambulatory surgery was practised in 81% of the hospitals. Sixty-six percent had a projects under consideration, including several at the decision making stage (17%). 1550 ambulatory surgery clinics could be created by the year 2000. In 66% of the cases, the future facility would be integrated into the traditional surgery unit. There was favorable opinion concerning the development of ambulatory surgery clinics in public hospitals in 83% of the cases. Inconveniences suggested generally involved organizational aspects, particularly concerning medical organization. Foreseen obstacles to the development of ambulatory surgery clinics were regulatory procedures, unfavorable exchange rate, insufficient investment funds and the lack of a policy favoring their development. CONCLUSION: The development of ambulatory surgery clinics in public hospitals in France can be expected in the near future. Budgeting and regulatory procedures must however be adapted to promote implementation of the existing projects.

Attitude of Health Personnel↗