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Biomedical subjects

D A Harrison

Publications and source records attributed to D A Harrison.

At least 55 records · Page 3Linked to original sources

Biomicroscopic evidence of keratoconus with an apex power of 45.5 diopters by videokeratoscopy.

PURPOSE/METHODS: We studied a mild case of keratoconus, which had biomicroscopic evidence of keratoconus. With videokeratoscopy, we examined a 55-year-old man with a family history of keratoconus who showed biomicroscopic evidence of bilateral keratoconus. RESULTS/CONCLUSIONS: Videokeratoscopy of the least affected eye showed a map pattern consistent with an inferiorly displaced cone, but surprisingly the apex power measured only 45.5 diopters. Patients with apex power as low as 45.5 diopters can show biomicroscopic evidence of keratoconus. If a central database existed for such unusual cases, eye-care specialists could contribute to it and provide valuable material to researchers trying to improve automated methods to differentiate between normal and keratoconic corneas.

Cornea↗

Resuscitation skills of trainee anaesthetists.

We assessed the basic and advanced cardiopulmonary resuscitation skills of 30 trainee anaesthetists in a simulated exercise. Only one person performed basic cardiopulmonary resuscitation as outlined in the 1992 European Resuscitation Council guidelines. The management of ventricular fibrillation and asystole were correctly carried out by eight (27%) and nine (30%) anaesthetists, respectively. Neither the seniority of the anaesthetists nor their postgraduate qualifications correlated with their performance level. We conclude that all trainee anaesthetists need to undergo regular training and assessment of their resuscitation skills.

Anesthesiology↗

Placebo-controlled trial of lithium augmentation of fluoxetine and lofepramine.

BACKGROUND: This study was designed to establish whether (as suggested in a number of open and relatively small controlled trials) lithium augmentation is more effective than continued antidepressant alone, where response to a standard course of antidepressant treatment has been absent or partial. METHOD: Lithium or placebo was added on a double-blind basis for six weeks to the drug regime of 62 patients with major depressive illness (in both hospital and primary care settings) who had failed to respond to a controlled trial of fluoxetine or lofepramine. Response was defined as a final Hamilton Depression Rating Scale (HDRS) score of < 10. RESULTS: Response was seen more frequently in patients taking lithium (15/29) than in those remaining on antidepressant alone (8/32; P < 0.05). Rapid response to lithium augmentation (LA) was not consistently observed in this cohort. Mean HDRS scores after six weeks were significantly lower (P < 0.01) in the lithium group after excluding those who had not achieved significant exposure to lithium (arbitrarily defined as two or more lithium levels > or = 0.4 mmol/l). No differences in the efficacy of LA were apparent between fluoxetine and lofepramine. CONCLUSIONS: Our results confirm that LA is a useful strategy in the treatment of antidepressant-resistant depression. Partial response was, however, frequently observed with continued antidepressant treatment alone, and the superiority of LA appears to depend on achieving adequate serum lithium levels.

Adolescent↗

Right-to-left shunt following repair of partial anomalous pulmonary venous connection: a novel use of the Rashkind double-umbrella occlusion device.

A patient with partial anomalous pulmonary venous connection complicated by postoperative occlusion of the distal superior vena cava and a baffle leak causing right-to-left shunt is described. Surgery was avoided by balloon dilation and stenting of the superior vena cava. The baffle leak was closed with a Rashkind double-umbrella device.

Adult↗

Platelet 5-HT uptake sites, labelled with [3H] paroxetine, in controls and depressed patients before and after treatment with fluoxetine or lofepramine.

Platelet [3H] paroxetine binding was measured in 73 depressed patients and in 64 healthy volunteers. No differences were found in Bmax or Kd either overall, or when the 61 depressed subjects who had never received psychotropic drugs were analysed separately. Within the depressed group, no differences in Bmax or Kd were found between subgroups divided on the basis of endogenicity, suicidal thoughts or severity of depression. None of the subgroups differed significantly from controls. Forty of the depressed subjects were retested after 6 weeks' treatment with fluoxetine (n = 22) or lofepramine (n = 18). Treatment was not associated with any change in Bmax but a similar and significant increase in Kd was noted following treatment with either antidepressant. Neither pre- nor post-treatment platelet binding parameters appeared to relate to clinical response to treatment.

Adolescent↗

Post-dural puncture headache: a comparison of the Sprotte and Yale needles in urological surgery.

One hundred elderly male patients undergoing transurethral surgery were allocated randomly to receive spinal anaesthesia with either a 26 gauge Yale needle or a 24 gauge Sprotte needle. Patients were visited within 48 h by an investigator who was unaware of the needle type used and specific enquiry was made about any headache which was characteristic of dural puncture. We found evidence of a postdural puncture headache in 15 (30%) patients in whom a 26 gauge Yale needle was used. By comparison, only three patients (6%) in the Sprotte group reported a postdural puncture headache. This represents a highly significant (P < 0.005) reduction in the incidence of postdural puncture headache. The incidence of multiple attempts at dural puncture was also significantly (P < 0.05) reduced to 16% in the Sprotte group compared with 28% in the Yale group.

Aged↗

Simple and efficient generation of marked clones in Drosophila.

BACKGROUND: Cell lineage analysis and mosaic analysis of mutations are important techniques that are used to study the development of many organisms. Unfortunately, the methods employed for such analyses are usually inefficient, technically demanding or labor intensive. In Drosophila, the most common methodology used for the generation of mosaic animals is mitotic recombination, which is induced by X-rays. Although this technique is simple, it has the undesirable characteristics of a low efficiency and a high rate of cell death. Furthermore, although a large number of marker systems has been employed to detect mitotic recombinants, none allows easy identification of clones for all cell types. RESULTS: A system is described here that allows a highly efficient generation of clones with the concomitant expression of an easily detectable cellular marker. This method can be applied to cell lineage and mosaic analysis in Drosophila. The site-specific yeast FLP recombinase, under the control of a heat shock-inducible promoter, efficiently catalyses mitotic recombination specifically at the site of a FLP recombination target (FRT). In this system, recombination fuses the alpha-tubulin promoter to the lacZ gene, allowing transcription of the marker. Recombinant cells and their progeny can, therefore, be detected by standard assays for beta-galactosidase. Of particular importance is the fact that only the cells of interest stain, thus allowing their simple detection in any tissue. CONCLUSIONS: We demonstrate that, by intermolecular recombination, we can use FLIP recombinase to generate marked clones efficiently in embryonic, larval and adult tissues. This simple and efficient technique is well suited to cell-lineage analysis and can be easily extended to the generation and detection of mutant clones in mosaic animals.

Journal Article↗

Radial keratotomy for intolerable myopia after penetrating keratoplasty.

Radial keratotomy was used to treat intolerable myopia in nine patients aged 56 to 86 years who had previously undergone penetrating keratoplasty and intraocular lens placement. The degree of myopia ranged from -5.25 to -9.25 diopters spherical equivalent before radial keratotomy. An eight-cut radial keratotomy with either a 4.0- or 4.50-mm central clear zone was performed on all patients. One year after the radial keratotomy, the spherical equivalent ranged from -1.25 to +1.63 diopters, which rendered all patients spectacle tolerant. Endothelial cell counts done before and one year after radial keratotomy demonstrated no marked loss of endothelial cell density. No complications were seen as a result of the radial keratotomy.

Aged↗

Cognitive processes in self-report responses: tests of item context effects in work attitude measures.

Much applied research relies on multi-item, self-report instruments. Drawing from recent cognitive theories, it was hypothesized that the items preceding a self-report item, its item context, can generate cognitive carryover and prompt context-consistent responses. These hypotheses were tested in 2 investigations: a field experiment involving 431 employees of a nonprofit urban hospital and a laboratory replication involving 245 undergraduate business students who held full- or part-time jobs. In both studies, evaluatively neutral items were placed in specially arranged blocks of uniformly positive, uniformly negative, or randomly mixed items on 3 modified Job Descriptive Index scales. Responses to the neutral items differed across the 3 forms, but scale-level psychometric properties remained unchanged. The implications of these item- and scale-level results for a variety of self-report measures in organizations are discussed.

Adult↗

The pressor response to venous cannulation: attenuation by prior infiltration with local anaesthetic.

We have compared the cardiovascular response to insertion of an 18-gauge venous cannula in 40 healthy patients. In 20 of the patients, cannulation was preceded by infiltration of local anaesthetic. Both rate-pressure product and mean arterial pressure increased significantly (P < 0.01) compared with baseline when no local infiltration was used, but there was no significant change from baseline when infiltration with local anaesthetic preceded cannulation. We conclude that there is a significant pressor response to venous cannulation which is obtunded by prior infiltration with local anaesthetic. We recommend, therefore, that s.c. injection of lignocaine should be considered before insertion of an i.v. cannula, especially in the high risk patient.

Adolescent↗

A leucine zipper domain of the suppressor of Hairy-wing protein mediates its repressive effect on enhancer function.

The suppressor of Hairy-wing [su(Hw)] protein mediates the mutagenic effect of the gypsy retrotransposon by repressing the function of transcriptional enhancers controlling the expression of the mutant gene. A structural and functional analysis of su(Hw) was carried out to identify domains of the protein responsible for its negative effect on enhancer action. Sequence comparison among the su(Hw) proteins from three different species allows the identification of evolutionarily conserved domains with possible functional significance. An acidic domain located in the carboxy-terminal end of the Drosophila melanogaster protein is not present in su(Hw) from other species, suggesting a nonessential role for this part of the protein. A second acidic domain located in the amino-terminal region of su(Hw) is present in all species analyzed. This domain is dispensable in the D. melanogaster protein when the carboxy-terminal acidic domain is present, but the protein is nonfunctional when both regions are simultaneously deleted. Mutations in the zinc fingers result in su(Hw) protein unable to interact with DNA in vivo, indicating a functional role for this region of the protein in DNA binding. Finally, a region of su(Hw) homologous to the leucine zipper motif is necessary for the negative effect of this protein on enhancer function, suggesting that su(Hw) might exert this effect by interacting, directly or indirectly, with transcription factors bound to these enhancers.

Amino Acid Sequence↗

The effect of the anaesthetist's attire on patient attitudes. The influence of dress on patient perception of the anaesthetist's prestige.

Two groups of adult patients (55 each) were visited pre-operatively by an anaesthetist who was dressed either formally or casually. Their response to this visit, their opinions regarding anaesthetists and their knowledge of anaesthetic work were elicited afterwards by means of a questionnaire. Patients' satisfaction with the anaesthetist and his/her visit was not influenced by dress. The anaesthetist was awarded a high level of prestige and the length of his/her training was recognised to be comparable to that of other professionals; 81.8% of patients thought that anaesthetists held a medical degree but only 35.4% thought that they worked in the intensive care unit. Patients expressed a preference for doctors to wear name tags, white coats and short hair but disapproved of clogs, jeans, trainers and earrings.

Adolescent↗

The performance of two intensive care humidifiers at high gas flows.

High continuous flow breathing systems are now available to provide fresh gas flows well in excess of 100 l.min-1 in continuous positive airway pressure systems used for respiratory support. The performance of two commonly used intensive care humidifiers, the Kendal Conchatherm and the Fisher and Paykel FP310 have been assessed at flows of 50, 75, 100, 125 and 150 l.min-1. Their performance when using two humidifiers connected in parallel and in series was also studied. At a fresh gas flow of 100 l.min-1 the single Conchatherm gave an absolute water vapour concentration of 15.6 g.m-3 and the single FP310 11.9 g.m-3. At all flows the best results were achieved using two Conchaterm humidifiers in series. It is concluded that with high continuous flow breathing systems the humidification achieved with conventional humidifiers may be inadequate and it may be necessary to combine two humidifiers to obtain clinically useful humidification.

Critical Care↗

Heterogeneity of type I collagen expression in human corneal keratoconus fibroblasts.

Corneal fibroblast cultures were established from 3 normal and 4 keratoconus (KC) corneas. Type I collagen protein synthesis and steady-state RNAs were analyzed in these cultures by metabolic labeling studies, slot blots and immunofluorescent microscopy. Type I collagen proteins and steady-state RNAs were reduced in cells from 3 of the 4 KC cultures when compared with normal fibroblasts, suggesting that collagen expression is heterogenous in KC and that the heterogeneity is expressed at the cellular and molecular level. The type I collagen matrix synthesized by the KC fibroblasts appeared normal when analyzed by immunofluorescence, suggesting that the incorporation of type I collagen into the extracellular matrix is not affected in KC fibroblasts.

Adult↗

Temporary sutured tube-tarsorrhaphy: reversible eyelid closure technique.

Temporary closure of the eyelids is frequently recommended for ocular surface disorders in which reepithelialization of the cornea is problematic, as well as for acute Bell's palsy. We describe an easily performed technique of temporary tarsorrhaphy using plastic tubes sutured externally to the upper and lower eyelids, with eyelid closure accomplished by tightening a loop of suture passed through the two tubes. Corneal epithelial defects in 11 of 13 patients in whom we used this technique resolved satisfactorily without complications. In the remaining two, the polypropylene sutures eroded through the eyelids between 5 and 6 weeks after surgery. The sutured tubes loosened and the loosened sutures had to be replaced. In one patient, the overly long end of a suture rotated between the apposed eyelids, inducing a corneal abrasion, but no permanent damage to the eye. We conclude that the sutured tube-tarsorrhaphy provides excellent short-term closure of the eyelids, while allowing simple, painless opening for examining the globe. The risks of inflammation and infection associated with previously described techniques are minimized.

Corneal Diseases↗

Detection of sequence variants in the gene for human type II procollagen (COL2A1) by direct sequencing of polymerase chain reaction-amplified genomic DNA.

The direct sequencing of the human type II procollagen (COL2A1) gene from polymerase chain reaction (PCR)-amplified genomic DNA is described. Thirty-two regions of the COL2A1 gene were asymmetrically amplified with intron primers which were specifically chosen to amplify a region spanning 500 to 800 bp of sequence encoding one or more exons and their accompanying intervening sequences. Primers for dideoxynucleotide sequencing of the PCR products were then designed to provide complete exon sequence information and to insure that intron:exon splice junction sequence data would be obtained. Amplification and sequencing reactions were performed on an automated workstation to facilitate the handling of multiple DNA templates. The procedure allowed efficient sequencing of over 25,000 bp of each allele of the COL2A1 gene per diploid genome. We used this method for the comparative analyses of COL2A1 sequences in DNA isolated from the blood of 42 unrelated individuals and we identified 21 neutral sequence variants in the gene. The sequence variations were confirmed by independent assays, including restriction enzyme digestion. The sequence variants described here will be important for identifying haplotypes of the type II procollagen gene that will be useful in defining a genetic etiology for diseases of cartilaginous tissues.

Alleles↗

Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula?

A recent study performed in this department showed that a subcutaneous injection of local anaesthetic was significantly less painful than the insertion of a 22-gauge venous cannula. However, our colleagues remained sceptical that local anaesthetic infiltration would eliminate the pain of cannulation. Consequently a further study was undertaken to compare the pain of cannulation with and without the use of local anaesthetic. The results show that pain of cannulation is significantly (p < 0.003) reduced after subcutaneous infiltration with 1% lignocaine when compared to cannulation without local infiltration. Persistent discomfort at the site of cannulation was eliminated by the use of local anaesthetic.

Adult↗