Common and unusual cases seen by an inpatient dermatology consult service.
This article describes common consult requests and presents case studies from the dermatology consult service of an academic hospital.
AIDS-Related Opportunistic Infections↗
Biomedical subjects
D A Jones
Publications and source records attributed to D A Jones.
Resolution of hypoxemia in a liver transplant recipient after ligation of a portosystemic shunt.
This report describes the unique development of pulmonary vascular dilatation and hypoxemia associated with a portosystemic shunt in a pediatric liver transplant recipient. Ligation of the shunt resulted in resolution of hypoxemia. The outcome suggests that hepatic venous return to the pulmonary circulation is important in maintaining normal pulmonary vascular caliber.
Child↗
Uptake of breast cancer screening in older women.
OBJECTIVES: to determine breast screening uptake in older women and to ascertain from previous non-attenders whether they would accept screening if invited. DESIGN: a random sample of older women randomly selected from three Family Health Service Authorities were interviewed in their homes. PARTICIPANTS: 1604 women aged 65 years and over living at home, a response rate of 94%. RESULTS: 120 respondents (8%) had previously been screened. Rates were higher among those who were married, separated or divorced than those who were single (P < 0.01). Of those who had not previously been screened, 742 (50%) reported that they would attend if invited. Age influenced potential attendance: 67% of those aged 65-69 would accept compared with 27% of those aged 80 and over (P < 0.0001). Future attenders were significantly more likely to belong to the upper social class and to be currently married, and were significantly less likely to be disabled or depressed, but more likely to be anxious (P < 0.05). CONCLUSIONS: it is unjustifiable to exclude women over 65 from breast screening on the basis of assumed low uptake rates. Certain categories of women--such as those who were physically disabled, depressed, single or from lower social classes--could be targeted to achieve maximum uptake rates.
Aged↗
Emergency repair of incidentally diagnosed ascending aortic aneurysm immediately after caesarean section.
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Aortic Aneurysm, Thoracic↗
Comparison of three methods for measuring the time spent in physical activity.
PURPOSE: Three methods for measuring time spent in daily physical activity (PA) were compared during a 21-d period among 83 adults (38 men and 45 women). METHODS: Each day, participants wore a Computer Science and Applications, Inc. (CSA) monitor and completed a 1-page, 48-item PA log that reflected time spent in household, occupational, transportation, sport, conditioning, and leisure activities. Once a week, participants also completed a telephone survey to identify the number of minutes spent each week in nonoccupational walking and in moderate intensity and hard/very hard-intensity PA. Data were analyzed using descriptive statistics and Spearman rank-order correlations. Three equations developed to compute CSA cut points for moderate and hard/very hard PA were also compared with the PA logs and PA survey. RESULTS: There was modest to good agreement for the time spent in different PA intensity categories between the three CSA cut point methods (r = 0.43-0.94, P < 0.001). Correlations between the CSA and PA logs ranged from r = 0.22 to r = 0.36, depending on the comparisons. Correlations between the survey items and PA logs were r = 0.26-0.54 (P < 0.01) for moderate and walking activities and r < 0.09 (P > 0.05) for hard/very hard activities. Correlations between the survey items and the CSA min per day varied according to the method used to compute the CSA intensity cut points. CONCLUSIONS: The results were consistent with findings from other PA validation studies that show motion sensors, PA logs, and surveys reflect PA; however, these methods do not always provide similar estimates of the time spent in resting/light, moderate, or hard/very hard PA.
Activities of Daily Living↗
Measuring physical activity with the behavioral risk factor surveillance system.
PURPOSE AND METHODS: Because regular physical activity reduces the risk of premature death and disability, accurate methods of population-based measurement are important for public health surveillance efforts such as those based on the Behavioral Risk Factor Surveillance System (BRFSS). The present study: 1) briefly reviews and compares currently available methods to measure physical activity using BRFSS data, 2) describes physical activity patterns in the United States using these state-aggregated measures, and 3) provides suggestions on future directions for practitioners and researchers. Using a random-digit dialing, telephone survey, we collected data for noninstitutionalized adults aged 18 yr and older. We analyzed BRFSS data for 1996 from 50 states and the District of Columbia and Puerto Rico (N = 124,085). Based on recent literature and public health priorities, we developed eight different physical activity indices (one vigorous and seven moderate). These varied in their threshold for duration, kcal expenditure, and in frequency and intensity of activity. RESULTS: Using different algorithms, the population prevalence of moderate physical activity ranged from about 20% to 38%. Only 20% of adults met the Healthy People 2000 definition for regular, sustained activity (> or =30 min of moderate activity per day for at least 5 d x wk(-1)). CONCLUSIONS: Considerable progress is needed if the United States is to reach the current public health goal for regular physical activity. Standardized approaches to analyzing and collecting physical activity data are essential for public health surveillance, policy making, and communication to the public.
Adolescent↗
The C-terminal dilysine motif confers endoplasmic reticulum localization to type I membrane proteins in plants.
The tomato Cf-9 disease resistance gene encodes a type I membrane protein carrying a cytosolic dilysine motif. In mammals and yeast, this motif promotes the retrieval of type I membrane proteins from the Golgi apparatus to the endoplasmic reticulum (ER). To test whether the C-terminal KKXX signal of Cf-9 is functional as a retrieval motif and to investigate its role in plants, green fluorescent protein (GFP) was fused to the transmembrane domain of Cf-9 and expressed in yeast, Arabidopsis, and tobacco cells. The fusion protein was targeted to the ER in each of these expression systems, and mutation of the KKXX motif to NNXX led to secretion of the fusion protein. In yeast, the mutant protein reached the vacuole, but plants secreted it as a soluble protein after proteolytic removal of the transmembrane domain. Triple hemagglutinin (HA)-tagged full-length Cf-9 was also targeted to the ER in tobacco cells, and cleavage was also observed for the NNXX mutant protein, suggesting an endoprotease recognition site located within the Cf-9 lumenal sequence common to both the GFP- and the HA-tagged fusions. Our results indicate that the KKXX motif confers ER localization in plants as well as mammals and yeast and that Cf-9 is a resident protein of the ER.
Amino Acid Motifs↗
Recent advances in molecular biological techniques and their relevance to pulmonary research.
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Animals↗
Inhibition of DNA methyltransferase stimulates the expression of signal transducer and activator of transcription 1, 2, and 3 genes in colon tumor cells.
Inhibitors of DNA methyltransferase, typified by 5-aza-2'-deoxycytidine (5-Aza-CdR), induce the expression of genes transcriptionally down-regulated by de novo methylation in tumor cells. We utilized gene expression microarrays to examine the effects of 5-Aza-CdR treatment in HT29 colon adenocarcinoma cells. This analysis revealed the induction of a set of genes that implicated IFN signaling in the HT29 cellular response to 5-Aza-CdR. Subsequent investigations revealed that the induction of this gene set correlates with the induction of signal transducer and activator of transcription (STAT) 1, 2, and 3 genes and their activation by endogenous IFN-alpha. These observations implicate the induction of the IFN-response pathway as a major cellular response to 5-Aza-CdR and suggests that the expression of STATs 1, 2, and 3 can be regulated by DNA methylation. Consistent with STAT's limiting cell responsiveness to IFN, we found that 5-Aza-CdR treatment sensitized HT29 cells to growth inhibition by exogenous IFN-alpha2a, indicating that 5-Aza-CdR should be investigated as a potentiator of IFN responsiveness in certain IFN-resistant tumors.
Antimetabolites, Antineoplastic↗
Ridges and rivers: a test of competing hypotheses of Amazonian diversification using a dart-poison frog (Epipedobates femoralis).
Mitochondrial DNA cytochrome b sequence data from a dart-poison frog, Epipedobates femoralis, were used to test two hypotheses of Amazonian diversification: the riverine barrier and the ridge hypotheses. Samples were derived from sites located on both banks of the Rio Juruá and on both sides of the Iquitos Arch in western Amazonia. The phylogeographic structure was inconsistent with predictions of the riverine barrier hypothesis. Haplotypes from opposite river banks did not form monophyletic clades in any of our phylogenetic analyses, nor was the topology within major clades consistent with the riverine hypothesis. Further, the greatest differentiation between paired sites on opposite banks was not at the river mouth where the strongest barrier to gene flow was predicted to occur. The results instead were consistent with the hypothesis that ancient ridges (arches), no longer evident on the landscape, have shaped the phylogeographic relationships of Amazonian taxa. Two robustly supported clades map onto opposite sides of the Iquitos Arch. The mean haplotypic divergence between the two clades, in excess of 12%, suggests that this cladogenic event dates to between five and 15 million years ago. These estimates span a period of major orogenesis in western South America and presumably the formation of these ancient ridges.
Animals↗
Contractile properties of the quadriceps muscle in individuals with spinal cord injury.
Selected contractile properties and fatigability of the quadriceps muscle were studied in seven spinal cord-injured (SCI) and 13 able-bodied control (control) individuals. The SCI muscles demonstrated faster rates of contraction and relaxation than did control muscles and extremely large force oscillation amplitudes in the 10-Hz signal (65 +/- 22% in SCI versus 23 +/- 8% in controls). In addition, force loss and slowing of relaxation following repeated fatiguing contractions were greater in SCI compared with controls. The faster contractile properties and greater fatigability of the SCI muscles are in agreement with a characteristic predominance of fast glycolytic muscle fibers. Unexpectedly, the SCI muscles exhibited a force-frequency relationship shifted to the left, most likely as the result of relatively large twitch amplitudes. The results indicate that the contractile properties of large human locomotory muscles can be characterized using the approach described and that the transformation to faster properties consequent upon changes in contractile protein expression following SCI can be assessed. These measurements may be useful to optimize stimulation characteristics for functional electrical stimulation and to monitor training effects induced by electrical stimulation during rehabilitation of paralyzed muscles.
Adult↗
The measurement of force/velocity relationships of fresh and fatigued human adductor pollicis muscle.
The purpose of the study was to obtain force/velocity relationships for electrically stimulated (80 Hz) human adductor pollicis muscle (n = 6) and to quantify the effects of fatigue. There are two major problems of studying human muscle in situ; the first is the contribution of the series elastic component, and the second is a loss of force consequent upon the extent of loaded shortening. These problems were tackled in two ways. Records obtained from isokinetic releases from maximal isometric tetani showed a late linear phase of force decline, and this was extrapolated back to the time of release to obtain measures of instantaneous force. This method gave usable data up to velocities of shortening equivalent to approximately one-third of maximal velocity. An alternative procedure (short activation, SA) allowed the muscle to begin shortening when isometric force reached a value that could be sustained during shortening (essentially an isotonic protocol). At low velocities both protocols gave very similar data (r2 = 0.96), but for high velocities only the SA procedure could be used. Results obtained using the SA protocol in fresh muscle were compared to those for muscle that had been fatigued by 25 s of ischaemic isometric contractions, induced by electrical stimulation at the ulnar nerve. Fatigue resulted in a decrease of isometric force [to 69 (3)%], an increase in half-relaxation time [to 431 (10)%], and decreases in maximal shortening velocity [to 77 (8)%] and power [to 42 (5)%]. These are the first data for human skeletal muscle to show convincingly that during acute fatigue, power is reduced as a consequence of both the loss of force and slowing of the contractile speed.
Adult↗
Automated exchange transfusion for life-threatening plasmodium falciparum malaria--lessons relating to prophylaxis and treatment.
We report a case of traveller to Kenya who contracted severe plasmodium falciparum malaria complicated by disseminated intravascular coagulation and acute renal failure. She had taken no antimalarial prophylaxis in view of concerns in the media regarding the adverse effects of mefloquine. There was a protracted delay before the diagnosis of malaria was made. Clinical recovery occurred following treatment with intravenous quinine, haemofiltration and manual/automated red-cell exchange transfusions. Automated red-cell exchange transfusion resulted in a marked decrease in the parasitaemia, before a response to quinine therapy would have been anticipated, leading to a successful outcome thereafter. In conjunction with other groups we therefore feel that exchange transfusions should be considered in seriously ill patients with falciparum malaria, multiorgan complications and parasitaemias greater than 10%.
Adult↗
Genomics and the discovery of new drug targets.
Molecular medicine and genomics technologies are inseparable for defining new molecular targets. cDNA databases and elementary informatic tools provide instantaneous glimpses of gene families or tissue-restricted expression patterns as a means of new target identification. In addition, cDNA microarrays and two-dimensional gel electrophoresis unmask the expression of genes with unassigned or unexpected functions. Depletion of mRNA with ribozymes or neutralization of proteins with intracellular antibodies enable investigators to reject or embrace new molecular hypotheses about the determinants of disease, pharmacology or toxicology.
Databases, Factual↗
Temperature effect on the rates of isometric force development and relaxation in the fresh and fatigued human adductor pollicis muscle.
The purpose of the present study was to investigate the effect of temperature on the rates of isometric force development and relaxation in electrically activated fresh and fatigued human adductor pollicis muscle. Following immersion of the lower arm for 20 min in water baths of four different temperatures, muscle temperatures were approximately 37, 31, 25 and 22 C. Maximal isometric force was reduced by 16.8 +/- 1.5 % at 22 C. The stimulation frequency-force and -rate of force development relationships were shifted to the left at lower temperatures. Q10 values for the maximal rates of force development and relaxation, and the times for 100 to 50 % and 50 to 25 % force relaxation, were about 2.0 between 37 and 25 C and about 3.8 between 25 and 22 C. However, the time for 50 to 25 % force relaxation had a relatively high Q10 value between 25 and 22 C (6.9) and this parameter also appeared to be more sensitive to fatigue compared to the other indices of relaxation. Nevertheless, the effect of fatigue on all parameters decreased with cooling over the entire (37-22 C) temperature range.
Adult↗
The influence of prior activity upon inspiratory muscle strength in rowers and non-rowers.
The aim of this study was to investigate whether a 'warm-up' phenomenon in the strength of the inspiratory muscles exists, and, under this assumption, whether whole body warm-up protocols or a specific respiratory warm-up is more effective in this respect. Eleven club level rowers performed a rowing warm-up, and twelve university students performed a general cycling warm-up. Both groups also performed a specific respiratory warm-up. Inspiratory muscle strength (Mueller manoeuvre) and lung function (flow-volume loops) were measured before and after the three conditions. Isokinetic strength during knee extension was measured before and after the rowing warm-up. The two whole body warm-up protocols had no effect on inspiratory muscle strength or any lung function parameter despite the significant (3.8+/-SD 1.4%; p<0.05) increase in peak torque that the rowing warm-up elicited. The respiratory warm-up induced a significant increase in inspiratory mouth pressure (8.5+/-1.8%; p<0.0001) but not in any other lung function parameter. Following the rowing incremental test to exhaustion, maximum inspiratory pressure decreased by 7.0+/-2.0%, which is an indication of respiratory muscle fatigue. These data suggest that the inspiratory muscle strength can be enhanced with preliminary activity, a phenomenon similar to the one known to exist for other skeletal muscles. In addition, a specific respiratory warm-up is more effective in this respect than whole body protocols.
Adult↗
Effects of basic training on material handling ability and physical fitness of British Army recruits.
No study has yet evaluated the efficacy of British Army basic training in improving material handling performance. Therefore, the purpose of this study was to evaluate the efficacy of the current British Army basic training in improving material handling performance and physical fitness. Forty-seven males (19.4 (3.2) years of age, 1753 (59) mm in height, 71.0 (9.6) kg in weight) and 10 females (21.5 (3.5) years, 1623 (45) mm, 62.5 (5.2) kg) served as subjects. Testing was carried out in the week prior to, and in the final week of, an 11-week basic training course. Maximal box lifts to two different heights, and repetitive lifting and carrying of a 10 kg load did not improve with training. Static (38 cm upright pull) and dynamic (incremental dynamic lift to 145 cm) lifting strength data concurred with the maximal box lift data in that no improvement was observed. Repetitive lifting and carrying of a 22 kg load improved (29.5%, p < 0.001), as did 3.2 km loaded march performance with 25 kg (15.7%, p < 0.001), but march performance with a 15 kg load did not. Predicted VO2max improved from 48.4 to 51.4 ml.kg-1.min-1, a change of 6.1% (p < 0.05). Fat-free mass increased by 0.9 kg (1.5%, p < 0.01), and body fat reduced by 2.7% of body mass (20.1%, p < 0.001), resulting in a loss of 1.2 kg of body mass (1.7%, p < 0.01). It is concluded that basic training in the British Army produces some favourable adaptations in recruits, especially in terms of aerobic fitness. However, the poor development of strength and material handling ability during training fails to improve the ability of soldiers to perform simulated military tasks, and it does little to reduce future injury risk while performing these tasks.
Adult↗
Social support and unsupportive social interactions: their association with depression among people living with HIV.
Although numerous studies of people living with HIV have focused on positive social support, researchers have directed surprisingly little attention to the nature and effects of negative social interactions in this population. Based on data from a diverse sample of people with HIV (N = 271), we conducted a factor analysis to develop the HIV version of the Unsupportive Social Interactions Inventory (USII). Four types of unsupportive or upsetting responses that an HIV-positive person might receive from others were identified: insensitivity, disconnecting, forced optimism and blaming. In analysis with a sub-sample of 96 people with HIV, unsupportive social interactions were only moderately correlated with social support, suggesting that these constructs are relatively independent. Using hierarchical regression analysis, we found that unsupportive social interactions predicted a significant amount of the variance in depression, beyond the variance accounted for by physical functioning and positive social support. Partial correlations indicated that the relationship between unsupportive social interactions and depression was not an artifact of trait negative affectivity. Favourable evidence of the USII's reliability and validity suggests that the instrument provides a useful tool for assessing unsupportive social interactions experienced by people with HIV. Practical implications of the findings and directions for future research are discussed.
Acquired Immunodeficiency Syndrome↗