Biomedical subjects
C Randall
Publications and source records attributed to C Randall.
Cause for concern?
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Dental management of the myasthenic patient.
Myasthenia gravis (MG) is an auto-immune disorder of neuromuscular transmission which results in weakness and fatigue of skeletal muscles. The defect in neuromuscular transmission is most commonly seen in the muscles of the eyes, face, neck and shoulders but, in some patients, the respiratory muscles are involved. Patients with this condition may present with problems that necessitate special consideration when managing their dental treatment. Patients who are only mildly affected by MG can be treated in general dental practice for routine care. There are no contra-indications to the use of local anaesthetic agents and the presence of a vasoconstrictor is desirable. More severely affected patients and those who are very anxious about dental treatment should be cared for within the hospital environment. In these patients, respiratory muscles may be affected and, as a result, a myasthenic crisis may arise which requires assisted ventilation and, in some cases, intubation. Those patients who are fearful of the dental environment are likely to be emotionally stressed during such times and this increases the risk of a myasthenic crisis; sedation techniques can be beneficial in this group of patients.
Anaesthetic solutions.
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A rare cause of upper airway obstruction in a 5-year-old girl: a laryngeal web.
A case is described of a 5-year-old girl with respiratory distress. She was intubated without difficulty, but developed respiratory distress on extubation. Laryngoscopy/bronchoscopy via a laryngeal mask airway revealed an extensive layngeal web which was removed with laser therapy. The causes and differential diagnosis of laryngeal web are discussed.
Molecular characterization of putative yolk processing enzymes and their expression during oogenesis and embryogenesis in rainbow trout (Oncorhynchus mykiss).
Vitellogenin is the major yolk protein precursor in fish, but little is known about its processing pathway in the oocyte, nor about mobilization of yolk proteins during embryogenesis. In this study we cloned three putative yolk processing enzymes; specifically, cathepsin B and L, and lipoprotein lipase (LPL), from the rainbow trout ovary and determined their patterns of gene expression, together with cathepsin D, during oogenesis and embryogenesis using reverse transcription-polymerase chain reaction. The approximate sizes of both cathepsin B and cathepsin L transcripts were estimated as 1.7-1.8 kilobases by Northern blot analysis. Cathepsin D mRNA and cathepsin L mRNA were expressed constitutively throughout vitellogenesis and embryogenesis, showing the highest levels of expression at around fertilization. Cathepsin B and LPL were expressed exclusively during oogenesis. Quantitatively, expression of cathepsin D mRNA was higher than cathepsin B, cathepsin L, and LPL mRNA throughout the period studied. The different patterns of expression for these genes during oogenesis and embryogenesis signify specific temporal roles in yolk protein processing.
Safe and easy method for secondary tracheo-oesophageal puncture.
We describe a method for performing secondary tracheo-oesophageal puncture in patients who have undergone total laryngectomy. The technique is straightforward and easy. It uses a minimum of readily available equipment with a simple modification to a standard pharyngoscope.
Adolescent Obsessive-Compulsive Drinking Scale: an assessment tool for problem drinking.
Alcoholism has been studied in adults and found to share obsessive-compulsive characteristics. The Yale-Brown Obsessive Compulsive Scale (YBOC) was used to quantify the measurements of this disorder. This study adapted the YBOC for use with adolescents/young adults in an attempt to measure the "craving" expressed as obsessive and compulsive phenomenon. The primary findings show that the obsessive compulsive dimensions of alcohol cravings, as described in adult populations, also exist in adolescent/young adults. The Adolescent Obsessive Compulsive Drinking Scale (A-OCDS) was developed utilizing idioms and language typical for the 17-20 age group. Various quantitative evaluations proved that the Interference and Irresistibility sub-scales were the primary dimensions causing the obsessive behavior. This study begins to address this aspect of adolescent substance abuse utilizing a tool that is easy to administer. Because of the ease of use, although not a diagnostic instrument, the A-OCDS may be useful for identifying problem drinking in adolescents as well as detecting impairment in function related to drinking.
Effects of melatonin on liver estrogen receptor and vitellogenin expression in rainbow trout: an in vitro and in vivo study.
Although melatonin is believed to mediate many seasonal and circadian effects of photoperiod on reproduction in salmonids, the precise mechanisms underlying such effects are still largely unknown. Recent data of the literature indicate a relationship between melatonin and expression of estrogen receptors (ER) in various tissues. In this study, the effects of melatonin on estrogen receptor and/or vitellogenin expression were studied by a combination of in vivo and in vitro experiments. In yeast stably expressing ER and transfected with an estrogen-responsive element-beta-galactosidase reporter gene, melatonin had no effect on basal or E2-stimulated ER expression. Incubation of hepatocyte aggregates with melatonin (10(-8) to 10(-4)) for 16 or 48 h did not modify the E2-stimulated ER and vitellogenin mRNA, as measured by dot blots. Finally, neither pinealectomy nor melatonin implants caused any effect on basal or E2-stimulated ER and vitellogenin mRNA contents in the liver. Altogether, these results suggest that, although we cannot exclude potential effects at the brain or pituitary levels, melatonin has no or little effects on estrogen receptor in the liver.
Field-based measurements of personal erythemal ultraviolet exposure through a common summer garment.
The research in this paper quantifies the solar erythemal UV exposures to the skin through a common summer garment during outdoor activities. The erythemal exposures under the garment for the wet white garment exceeded a MED (minimum erythemal dose) at some anatomical sites in summer for a two-hour period. An erythemal exposure of 1.7 MED, in excess of the occupational limit for UV exposure, was measured under the white garment during swimming for a one-hour period. Clothing must form an important component of a UV protection strategy. However, it must be realised that total UV protection is not provided and significant UV exposures may be received beneath the garment, particularly for a white garment in the wet state. This re-enforces the necessity of a combination of several UV prevention strategies to minimise UV exposure.
Randomized controlled trial of nettle sting for treatment of base-of-thumb pain.
There are numerous published references to use of nettle sting for arthritis pain but no randomized controlled trials have been reported. We conducted a randomized controlled double-blind crossover study in 27 patients with osteoarthritic pain at the base of the thumb or index finger. Patients applied stinging nettle leaf (Urtica dioica) daily for one week to the painful area. The effect of this treatment was compared with that of placebo, white deadnettle leaf (Lamium album), for one week after a five-week washout period. Observations of pain and disability were recorded for the twelve weeks of the study. After one week's treatment with nettle sting, score reductions on both visual analogue scale (pain) and health assessment questionnaire (disability) were significantly greater than with placebo (P = 0.026 and P = 0.0027).
Central melatonin receptors in the rainbow trout: comparative distribution of ligand binding and gene expression.
To better define the role of melatonin in fish, we have compared in detail the distribution of 2-[125I]iodomelatonin binding sites with gene expression for melatonin receptor subtypes in a widely studied seasonal species, the rainbow trout. Three distinct partial sequences of the melatonin receptor gene were cloned from trout genomic DNA. Two of the sequences corresponded to the Mella receptor subtype, and one corresponded to the Mellb receptor subtype. Analysis of numerous clones failed to find a sequence equivalent to the Mel1c receptor subtype. Comparison of receptor gene expression with 2-[125I]iodomelatonin binding distribution indicated dendritic transport of the receptor. Melatonin receptors were associated predominantly with visually related areas of the trout brain, such as the thalamic region, the pretectal area, and the optic tectum. The pituitary was devoid of 2-[125I]iodomelatonin binding, and melatonin receptor gene expression was not detectable. It would appear from the results of the present study that melatonin in this species is involved primarily in the processing of visual signals. How melatonin interacts with circannual rhythms of growth and reproduction is unclear, although a direct interaction between melatonin and the hypothalamo-pituitary axis is not clearly indicated.
Nettle sting of Urtica dioica for joint pain--an exploratory study of this complementary therapy.
This exploratory study aims to explore the present use of the common stinging nettle to treat joint pain. Eighteen self-selected patients using the nettle sting of Urtica dioica were interviewed. Information regarding patients' use of nettle therapy was elicited, in particular mode of application, dosage and effects. All except one respondent were sure that netles had been very helpful and several considered themselves cured. No observed side effects were reported, except a transient urticarial rash. This exploratory study suggests nettle sting is a useful, safe and cheap therapy which needs further study. A randomized controlled trial is planned in collaboration with a rheumatology specialist.
Fluoride uptake by hydroxyapatite formed by the hydrolysis of alpha-tricalcium phosphate.
Although there is interest in forming synthetic analogs of hard tissues at physiologic temperature, significant gaps in knowledge exist with respect to the mechanisms by which precursor solids convert to apatites and also with respect to the apatite compositions that may be formed. In this study calcium-deficient HAp [Ca9(HPO4)(PO4)5OH] was prepared by hydrolysis of tricalcium phosphate (TCP), alpha-Ca3(PO4)2. The kinetics of HAp formation were studied as a function of temperature by isothermal calorimetry. TCP hydrolyzed completely within about 12 h, and the hydrolysis reaction evolved 133 kJ/mol of HAp formed. Although the kinetics of hydrolysis exhibited a strong temperature dependence, the mechanistic path taken appeared independent of temperature. The fluoridation of hydroxyapatite compositions having Ca/P ratios higher than 1.59 previously has been investigated. However, little work has been done on the fluoridation of more calcium-deficient hydroxyapatite. Ca9(HPO4)(PO4)5OH was formed at temperatures between 37.4 degrees and 55 degrees C to vary its morphology. These preparations then were reacted in NaF solution and the kinetics of fluoride incorporation studied. Solution chemical analyses were used to determine the amounts of fluoride incorporated. The extent of hydroxyl replacement by fluoride ranged from 17 to 72% and correlated with the surface area of the parent HAp.
A comparison of nursing intervention classification and current procedural terminology codes for representing nursing interventions in HIV disease.
The purpose of this study was twofold: 1) to compare the ability of terms from the nursing intervention classification and from the current procedural terminology to represent the clinical terms used by nurses and patients to describe nursing interventions during hospitalization; and 2) to identify the strengths and weaknesses of the two classification systems for representing nursing systems. More NIC than CPT codes matched the concepts in the clinical terms used by nurses and patients to describe nursing interventions demonstrating, not unexpectedly, that NIC represents a broader scope of nursing practice. The major difficulty encountered using NIC was the lack of mutual exclusiveness of the nursing activities within the interventions. CPT codes were easy to apply to the clinical terms, but were limited in scope for nursing practice. The findings of this study demonstrate the necessity of using a nursing-specific classification system for the representation of nursing interventions. This is of particular importance for databases that will be used to examine the effectiveness of healthcare interventions and for databases related to reimbursement for healthcare interventions.
Synovial sarcoma of the larynx in a child: case report and histological appearances.
Synovial sarcoma of the larynx is extremely rare having been reported only six times previously in the literature. We add another case report, which to our knowledge is the first recorded case in a child. We discuss the alternative approach of combination chemotherapy and radiotherapy which in this case led to a remission lasting about 3 years. The immunohistological and ultrastructural characteristics of the tumour are also presented.
Evaluating the long-term performance of a foam-core hospital replacement mattress.
Many hospitals have begun replacing their standard mattresses with pressure-reducing foam mattresses to eliminate the costly overlays that have been used for comfort and to protect patients at risk for development of pressure ulcers. Although researchers have tested the performance of new mattresses and have shown that many may be of use with patients at high risk, no information is available on the pressure-reducing capabilities of used mattresses. This study was designed to evaluate changes with use in the support characteristics of foam-core hospital replacement mattresses. In the first part of the study, interface pressure measurements were made at regular intervals over an extended period of use. Sixty mattresses were randomly selected from 750 mattresses currently in use at St. Luke's Episcopal Hospital, Texas Medical Center, Houston. The mattresses were labeled and marked at three selected points, and interface pressures under a standard load were measured at approximately 3-month intervals for 12 months. In the second part of the study, the stiffness of the foam, a measure of the foam's ability to support a weight, was measured at selected points on the mattresses. Patient reports of discomfort in the sacral area and of "sinking" into the middle of the mattress prompted this phase of the study. The stiffness profiles of 25 new mattresses were compared with those of 25 randomly selected mattresses that had been in regular use for at least 24 months. Data analyzed from part one showed trends that indicated that the interface pressures increased at each site during the course of the study; however, an analysis of variance indicated that the changes were not statistically significant during the time frame of the study.(ABSTRACT TRUNCATED AT 250 WORDS)
Miscarriage at home.
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