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Biomedical subjects

D A Porter

Publications and source records attributed to D A Porter.

At least 37 records · Page 2Linked to original sources

Quantitative MR diffusion mapping and cyclosporine-induced neurotoxicity.

Apparent diffusion coefficient maps of two patients with cyclosporine-induced neurotoxicity showed areas of increased diffusion that corresponded to the characteristic regions of signal change on routine T2-weighted sequences. The majority of lesions subsequently resolved without residual T2 or diffusion signal alteration. These findings suggest that, in our patients, the neurotoxic effects of cyclosporine resulted in a partially reversible extravasation of fluid into the cerebral interstitium and were not associated with acute ischemia.

Anemia, Sickle Cell↗

Blood oxygenation level dependent signal time courses during prolonged visual stimulation.

Previous functional magnetic resonance imaging (MRI) studies using extended visual stimulation have reported disparate results. Two studies have shown that blood oxygen level dependent (BOLD) contrast decays over time which is cited as evidence of recoupling between oxygen utilisation and cerebral blood flow during stimulus presentation. These findings have serious implications for the design of functional MRI experiments because they raise the possibility that BOLD contrast may not accurately reflect neuronal activity. Another study reported no decay of BOLD contrast. These studies used different visual stimuli and imaging techniques. We have performed a series of experiments, using different MRI techniques (echo-planar imaging and fast low angle shot) and two different visual stimuli to assess which of these factors may explain the previous results. In all of our experiments the signal time course from areas of significant activation remained largely elevated throughout the duration of stimulation and this is not affected by the imaging method used. Our data, in accordance with that of Bandettini et al., suggest that recoupling between blood flow and oxygen extraction is not a general phenomenon in the human brain when visual stimuli are presented for an extended time.

Adult↗

Posterior tibial tendon tears in young competitive athletes: two case reports.

Unlike the Achilles tendon, the posterior tibial tendon does not typically undergo acute rupture. We report two cases of posterior tibial tendon tears occurring in young, athletic individuals (<30 years old) that required operative intervention before the patients could return to competitive sports. We believe that these are the first two reports of posterior tibial tendon tears occurring in this population without the patient having a prior history of steroid injections in the tendon. The tears we observed and described at surgical exploration were chronic and degenerative in nature. We also comment on our approach to treatment of posterior tibial tendon injuries in the athletic population.

Adolescent↗

Potentiation of Fas-mediated apoptosis of murine granulosa cells by interferon-gamma, tumor necrosis factor-alpha, and cycloheximide.

The Fas antigen is a transmembrane receptor belonging to the tumor necrosis factor-alpha (TNF) receptor family that, when activated by Fas ligand or agonistic antibodies, induces death by apoptosis. Although the presence of Fas antigen in ovarian tissues has been demonstrated, little is known about whether Fas antigen is functional in the ovary. This report shows that murine granulosa cells are initially resistant to antibody-induced Fas-mediated apoptosis, but will undergo apoptosis when cotreated with TNF and interferon-gamma (IFN) or cycloheximide (CX). Granulosa cells were obtained from follicles of 23-day-old mice 2 days after injection of PMSG. Twenty-four hours after plating, cells were pretreated with either 0 or 200 U/ml IFN, which has been shown to induce Fas antigen expression and is required for Fas-mediated killing in many cell types. At 48 h, cells were treated with 2 microg/ml control IgG, 2 microg/ml anti-Fas antigen antibody (Fas mAb), 10 ng/ml TNF, or Fas mAb and TNF. Cytotoxicity (percent killing) relative to control IgG was determined at 72 h by counting granulosa cells after trypsinization. In the absence of IFN, no cytotoxicity was observed. In the presence of IFN, neither TNF or Fas mAb alone was cytotoxic, but the combination of Fas mAb and TNF resulted in 25% killing (P < 0.05). Fas antigen messenger RNA (mRNA) was detectable in cultures not treated with cytokines and was increased 5-fold by TNF, 2-fold by IFN, and 17-fold by the combination of IFN and TNF. To test whether the presence of a labile inhibitor(s) of Fas-mediated killing in granulosa cells is the cause of resistance to Fas mAb, the protein synthesis inhibitor CX was used. Experiments were performed as described above, except that cells were treated with 0.5 microg/ml CX in conjunction with other treatments at 48 h. Fas mAb treatment in the presence of CX induced 25% cell death without IFN pretreatment and 38% with IFN (P < 0.05). TNF treatment in the presence of CX had no effect alone, but potentiated the effects of Fas mAb, resulting in 56% killing in the absence of IFN and 86% killing in the presence of IFN (P < 0.05). Cells stained positively for DNA fragmentation and annexin V binding, features characteristic of apoptosis. Because initial experiments showed that treatment with TNF alone increased Fas mRNA levels, the effect of pretreating cells for 24 h with TNF before treatment with Fas mAb was tested. Pretreatment with TNF or IFN alone did not promote Fas mAb-mediated killing, but combined pretreatment with TNF and IFN resulted in 25% killing in response to Fas mAb. Treatment of cells with the combination of IFN and TNF induced a 19-fold increase in Fas antigen mRNA levels. Corresponding increases in Fas antigen protein expression on the surface of cells in response to cytokine treatments were detected by immunocytochemistry. Human TNF did not duplicate the effects of mouse TNF in inducing Fas antigen mRNA expression and Fas mAb-induced killing. As human TNF interacts exclusively with the type I, but not the type II, TNF receptor in the mouse, potentiating effects of mouse TNF on the Fas pathway are probably mediated via the type II TNF receptor. The effects of cytokine treatments on levels of mRNA for FAP-1, an inhibitor of Fas-mediated apoptosis, were determined. FAP-1 mRNA was detectable in untreated granulosa cells, and levels were not altered by treatment with TNF and/or IFN. In summary, the Fas-mediated pathway of apoptosis is functional in mouse granulosa cells that are stimulated with IFN and TNF. These cytokines may function at least partially by increasing Fas antigen expression. Granulosa cells appear to have inhibitors of the Fas antigen pathway, as treatment with CX potentiates Fas-mediated death. TNF promotes Fas-mediated killing in the presence and absence of CX. Therefore, TNF is not likely to act simply by increasing Fas antigen expression or decreasing protein inhibitors of the Fas pathway, because TNF remains effec

Animals↗

Proton magnetic resonance spectroscopy in MRI-negative temporal lobe epilepsy.

OBJECTIVE: To determine the 1H MRS findings in patients with intractable temporal lobe epilepsy (TLE) who had no detectable abnormality on either qualitative or quantitative MRI. BACKGROUND: Previous work has indicated that approximately 20% of patients with TLE remain MRI negative after extensive qualitative and quantitative investigation. Single-voxel 1H MRS provides a means of identifying potentially diffuse disease. METHODS: Seven patients with intractable TLE, normal routine MRI, normal hippocampal volumes, and normal hippocampal and amygdala quantitative T2 values underwent single-voxel 1H MRS of the medial temporal lobes. The results are compared with those from 13 control subjects and 15 patients with evidence of hippocampal sclerosis (HS). RESULTS: The ratio N-acetylaspartate/(choline-creatine + phosphocreatine) was abnormally low in five of the seven MRI-negative patients. In two of these patients, the ratios were low bilaterally. The observed MRS ratios in the MRI-negative group with abnormal EEG were similar to those from temporal lobes ipsilateral to HS, suggesting the presence of widespread or diffuse disease of a similar degree in both groups. CONCLUSIONS: These results demonstrate that MRS can provide evidence of temporal lobe abnormalities in TLE patients who show no abnormality on extensive MRI investigation.

Adult↗

Primary care of foot and ankle injuries in the athlete.

A thorough knowledge of foot and ankle anatomy is required to allow an accurate and focused examination of the injured athlete. This short review has attempted to educate the treating physician on our approach to foot and ankle injuries commonly seen in athlete. We have tried to elucidate less common injuries that present in similar manner to the more common foot and ankle sprains and strains.

Ankle Injuries↗

Primary repair without augmentation for early neglected Achilles tendon ruptures in the recreational athlete.

From 1987 to 1994, the senior author performed 41 Achilles tendon repairs. We identified 11 patients during this period (age, 35.3 years; range, 26-60 years) who fit the criterion for neglected Achilles tendon rupture (repair > or = 4 weeks and < or = 12 weeks from injury). All patients underwent proximal release of the gastrocsoleus complex, imbrication of the early fibrous scar without excision of any local tissue, and primary repair of the tendinous ends with two No. 5 Ticron sutures (5R, 6L). Several (three to five) No. 0 Vicryl sutures were used to augment the repair. The ankle was placed in a 20 degree plantarflexion nonweightbearing short leg cast for 3 weeks. All skin closures were primary. At 3 weeks, weightbearing as tolerated was initiated in a short leg cast. The cast was discontinued at 6 weeks, and physical therapy was initiated, consisting of range of motion exercises and closed kinetic exercises, progressing to functional exercises as swelling, strength, and pain allowed. Minimal follow-up was 18 months (mean, 3.5 years; range, 1.5-5.8 years). There have been no subsequent ruptures to date. All patients returned to a preinjury level of activity at a mean of 5.8 months (range, 2.5-9 months). Total range of motion was not different (P > 0.05) between the involved (67 degree) and uninvolved (74 degree) ankle. Plantarflexion loss of strength in the involved ankle was the same (98.4%, 88.1%, and 87.6% respectively, involved to uninvolved) as that seen after acute repair at all speeds tested. Visual analog pain scale (0 to 10) revealed a mean score of 0.7 (range 0-2) during activities of daily living and 1.0 (range, 0-3) during sports activity. The subjective and objective outcome was similar (P > 0.05) to that seen after an acute repair by the same surgeon. There were no complications including skin sloughs or nerve damage. We believe this is the first article to report the results after primary repair without augmentation for the neglected Achilles tendon rupture. We conclude that this approach can result in excellent clinical and functional outcome, a low rate of subsequent rupture, and a high rate of return to sports in the recreational athlete whose repair is performed between 4 and 12 weeks after injury.

Achilles Tendon↗

Rehabilitation after meniscal repair.

Meniscal repair as an isolated procedure should be considered for patients who present with clinically symptomatic meniscal tears and who have large, unstable, peripheral, bucket-handle meniscal tears at arthroscopy. Successful repair relieves meniscal symptoms and allows the patient to return to full function. In the authors' study population, patients with adequate repair of the meniscal tears followed a rehabilitation program that allowed immediate ROM and weight bearing as tolerated. They achieved a clinical result comparable to patients who followed a restrictive rehabilitation program. By using a less restrictive rehabilitation program, surgeons may offer patients who require meniscal repairs a program with a shorter interval between the surgical procedure and full return to the activities of daily living and athletics than was offered by previous regimens. From the evidence obtained from the study population using the authors' selection criteria and surgical technique, the accelerated rehabilitation program does not compromise the clinical result. The follow-up period is too short to determine if repair will be successful in protecting the knee joint from the known degenerative changes that follow meniscectomy. It is certain, however, that surgical repair that preserves meniscal tissue can relieve symptoms and allow patients to return to activities at their own pace. Many questions remain to be answered, all of which need to be addressed in the future: What is the natural history of an untreated meniscal tear in an ACL-stable and in an ACL-injured knee? Is suturing necessary for meniscal tears? If so, what type of suturing technique should be used? Is some type of meniscal abrasion or stimulation of the meniscal tear needed to obtain healing? What is the likelihood of a healed, repaired meniscus to retear in the future, even if the initial repair has been successful, especially on the medial side? At present, there is no universal agreement as to what rehabilitation protocol is best. For the past 8 years, the authors have undertaken an accelerated rehabilitation program following isolated meniscal repairs and also following repairs performed in conjunction with ACL reconstructions. With constant patient evaluation and follow-up, clinically successful results have been achieved. A well-designed, prospective, multicenter study of isolated meniscal repair comparing different rehabilitation protocols is desirable to resolve the existing controversial issue of rehabilitation after meniscal repair.

Anterior Cruciate Ligament Injuries↗

The effect of oral coenzyme Q10 on the exercise tolerance of middle-aged, untrained men.

In order to determine the effect of oral Coenzyme Q10 (CoQ10) dosing on exercise capacity, 15 middle-aged men (44.7 +/- 2.0 years) received either CoQ10 (150 mg/day x 2 months-Q10 GRP) or placebo (2 months-CON GRP). Blood CoQ10 levels increased (p < 0.05) during the treatment in the Q10 GRP (Pre = 0.72 +/- 0.06, 2 months = 1.08 +/- 0.14 micrograms/ml) and were unchanged in the CON GRP (Pre = 0.91 +/- 0.05, 2 month = 0.69 +/- 0.05 microgram/ml). Similarly, the subjective perception of vigor (visual analog scale 1-10 where, 10 = very energetic, and 0 = very, very unenergetic) increased (p < 0.05) in the Q10 GRP (Pre = 5.73 +/- 0.35, 2 month = 6.64 +/- 0.45). However, maximal oxygen consumption (VO2max Pre = 2.97 +/- 0.18, 2 month = 3.05 +/- 0.15 l/min) and lactate threshold (LT Pre = 2.04 +/- 0.12, 2 month = 2.08 +/- 0.12 l/min), as measured on the cycle ergometer, were unchanged as a result of the CoQ10 treatment, Neither forearm oxygen uptake, nor forearm blood flow was found to be affected by the CoQ10. Although lactate release during hand-grip testing tended to decrease in the Q10 GRP (Pre = 227 +/- 49, 2 month = 168.3 +/- 40 mumole/min) this was not significant (p > 0.05). It can be concluded that short-term (2 months) oral dosing with CoQ10 increases circulating blood levels of CoQ10 and the subjective perceived level of vigor in middle-aged men. However, short-term dosing does not improve aerobic capacity or firearm exercise metabolism as measured in this investigation.

Administration, Oral↗

Phosphorus-31 metabolism of post-menopausal breast cancer studied in vivo by magnetic resonance spectroscopy.

We have studied the metabolism of 31P-containing metabolites of post-menopausal breast cancers in vivo using magnetic resonance spectroscopy (MRS) and a 5.5 cm surface coil. Spectra were acquired from 23 diameter. The spectra of the 19 previously untreated tumours had significantly higher phosphomonoester (PME) 31P relative peak areas than the normal breasts of eight post-menopausal women (11.7% and 7.7% respectively, P = 0.002). Although an increased PME relative peak area was characteristic of malignancy, PME relative peak area is similarly raised in lactating breast and, therefore, not a specific feature of cancer. An apparently lower nucleotide triphosphate (NTP) relative peak area in tumours than healthy postmenopausal breast was secondary to the differences in PME relative peak area; contamination by signal from chest wall muscle probably accounts for the ostensibly higher phosphocreatine (PCr) relative peak area of the tumours. Spectroscopy was repeated following chemotherapy in six women. An increase in PCr relative peak area was seen in all five patients who responded, but again this may represent increased contamination secondary to changes in tumour size. A fall in PME relative peak area was noted in four responders, but also one non-responder, so this finding may not be sufficiently specific to be of use clinically. Further studies are need to elucidate fully the role of MRS in breast cancer.

Adult↗

Phosphorus-31 metabolism of human breast--an in vivo magnetic resonance spectroscopic study at 1.5 Tesla.

We have studied the metabolism of compounds containing 31P in normal breast using magnetic resonance spectroscopy (MRS). Spectra were acquired from non-lactating pre-menopausal breast (n = 14 women), lactating breast (n = 8) and post-menopausal breast (n = 8). The standard acquisition protocol used a 5.5 cm surface coil with the volunteer prone to minimize chest wall signal contamination. In pre-menopausal non-lactating women the phosphocreatine (PCr) peak area, expressed relative to the sum of all 31P peak areas, was negatively correlated with breast size (r = -0.56, p = 0.02) suggesting that much of the PCr signal originated from the chest wall. The phosphodiester (PDE) relative peak area was positively correlated with breast size (r = 0.71; p = 0.002). Spectra could be acquired at all phases of the menstrual cycle. In sequential examinations of five women not taking the oral contraceptive pill (OCP), phosphomonoester (PME) relative peak area was significantly lower on Week 2 than other weeks of the cycle (p = 0.03). Among pre-menopausal women no clear difference was apparent between the spectra from women taking the OCP and those not taking the OCP. Lactating breast had significantly higher PME relative peak area than non-lactating pre-menopausal breast (p = 0.02), probably reflecting the higher proportion of epithelial tissue in lactation; the lower PCr relative peak area in lactating breast (p = 0.05) is probably due to the greater size of the breast during lactation. Spectra were acquired from post-menopausal women but with a relatively low signal-to-noise ratio. The only significant difference between 31P relative peak areas of breast spectra acquired from pre- and post-menopausal women was that less PCr was detected in the post-menopausal volunteers (p = 0.03), probably as a result of differences in breast size.

Breast↗

A new in vitro method for assessing the potential toxicity of soft contact lens care solutions.

We describe a method for determining the cytotoxic effect of soft contact lens care solutions. The method provides a means for the direct exposure of mammalian cells to solutions and to lenses that have been soaked in solutions. Cytotoxicity was indicated by significant increases in the number of dead cells relative to controls. The cytotoxicity of a test battery of eight compounds was determined, particularly benzalkonium chloride (BAK). In addition, nine commercial soft contact lens care products containing a variety of preserving/disinfecting agents were also examined. A modification of the basic assay for assessing the kinetics of toxicity is also described. The results indicate that this new method is useful for identifying compounds that bind to soft contact lenses, such as BAK, and induce cytotoxicity and others that should be rinsed from lenses or neutralized (such as hydrogen peroxide) to minimize the potential for irritation.

Animals↗

Familial periodic cerebellar ataxia: a problem of cerebellar intracellular pH homeostasis.

Six affected members of two families with familial periodic cerebellar ataxia were relieved of their symptoms with oral acetazolamide. Phosphorus 31 (31P) nuclear magnetic resonance spectroscopy showed abnormal intracellular pH levels in the cerebellum of all subjects when they were not treated. These levels returned to normal with treatment. Cerebral pH values were also measured in one family and were normal before and after treatment. An additional 3 patients with similar attacks, but without a family history, had normal untreated pH values in the cerebellum and cerebrum.

Acetazolamide↗

Nucleotide sequence of the cDNA encoding the common alpha subunit of the chicken pituitary glycoprotein hormones.

Recombinant cDNA clones that encode the alpha subunit of the chicken pituitary glycoprotein hormones were isolated from a pituitary library. The longer of the two cDNA clones that were sequenced was 754 bp in length. It contained 81 nucleotides of the 5'-untranslated region (UTR), an open-reading frame of 360 bp that encoded a 24 amino acid leader polypeptide sequence as well as the 96 amino acid mature alpha subunit, and 268 nucleotides of the 3'-UTR, followed by a 45 bp poly(A) tract. There was 69-79% homology between the nucleotide sequence of the coding region for the chicken and mammalian alpha-subunit cDNAs. Northern blot analysis revealed that the steady-state levels of an approximately 800 bp alpha-subunit specific transcript increased quantitatively when dispersed chicken pituitary glands were treated in culture with chicken gonadotrophin-releasing hormone-I.

Amino Acid Sequence↗

D-value determinations are an inappropriate measure of disinfecting activity of common contact lens disinfecting solutions.

Determination of a D value for specific test organisms is a component of the efficacy evaluation of new contact lens disinfecting solutions. This parameter is commonly defined as the time required for the number of surviving microorganisms to decrease 1 logarithmic unit. The assumption made in establishing a D value is that the rate of kill exhibits first-order kinetics under the specified conditions. Such exponential kill rates are seen with thermal contact lens disinfection system. A comparison of the death rate kinetics for a variety of chemical contact lens disinfecting solutions was undertaken to ascertain the suitability of D-value determination for these chemical disinfectants. The active agents of these different solutions included hydrogen peroxide, thimerosal, chlorhexidine, tris(2-hydroxyethyl)tallow ammonium chloride, thimerosal, polyaminopropyl biguanide, and polyquaternium-1. The solutions were challenged with 10(6) CFU of either Pseudomonas aeruginosa, Serratia marcescens, or Staphylococcus hominis per ml, and survival rate was determined. This study clearly demonstrates the nonlinear nature of the inactivation curves for most contact lens chemical disinfecting solutions for the challenge organisms. D-value determination is, therefore, an inappropriate method of reporting the biocidal activity of these solutions.

Contact Lenses↗

Low-velocity knee dislocation.

Complete knee dislocation is an uncommon but potentially devastating injury with a reported high rate of neurovascular injury. Treatment of this ligamentous injury is controversial. The operative (repair of all ligaments) and nonoperative management of ligament injuries appears to result in a stiff knee (decreased range of motion [ROM]), and/or a significant incidence of clinical instability and pain. We report our data on low-velocity knee dislocations and present a treatment plan of noninvasive assessment of the vascular status, a stabilizing procedure centered on posterior cruciate ligament reconstruction (PCL) and an aggressive rehabilitation program that can result in improved ROM, acceptable stability, and a more optimal functional outcome.

Adolescent↗