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Biomedical subjects

D A Ross

Publications and source records attributed to D A Ross.

At least 73 records · Page 4Linked to original sources
PubMed1999

Use of hydroxyapatite bone cement to prevent cerebrospinal fluid leakage through the frontal sinus: technical report.

OBJECTIVE: To test the efficacy of a simple technique of frontal sinus obliteration during low frontal craniotomy using hydroxyapatite cement instead of more traditional methods, such as pericranial flaps, free muscle or adipose grafts, lumbar drainage, or fibrin glue. METHODS: Eight patients undergoing low frontal craniotomy for intradural surgery had the frontal sinus obliterated by careful removal of mucosa followed by filling of the sinus with hydroxyapatite bone cement. No other adjuncts for preventing cerebrospinal fluid leakage through the sinus were used. RESULTS: At an average follow-up of 9 months, there were no cerebrospinal fluid leaks, infections, instances of resorption, or cosmetic deformities. CONCLUSION: Hydroxyapatite bone cement seems to be a simple and effective method for frontal sinus obliteration and prevention of cerebrospinal fluid leakage.

Aged↗
PubMed1999

Muscarinic receptor loss and preservation of presynaptic cholinergic terminals in hippocampal sclerosis.

PURPOSE: Prior single-photon emission tomography studies showed losses of muscarinic acetylcholine receptor (MAChR) binding in patients with refractory mesial temporal lobe epilepsy. Experimental animal studies demonstrated transient losses of MAChR due to electrically induced seizures originating in the amygdala. However, the relations between cholinergic synaptic markers, seizures, and underlying neuropathology in human temporal lobe epilepsy are unknown. We tested the hypotheses that human brain MAChR changes are attributable to hippocampal sclerosis (HS), and that HS resembles axon-sparing lesions in experimental animal models. METHODS: We measured MAChR binding-site density, an intrinsic neuronal marker, within the hippocampal formation (HF) in anterior temporal lobectomy specimens from 10 patients with HS and in 10 autopsy controls. Binding-site density of the presynaptic vesicular acetylcholine transporter (VAChT) was measured as a marker of extrinsic cholinergic afferent integrity. MAChR and VAChT results were compared with neuronal cell counts to assess their relations to local neuronal losses. RESULTS: Reduced MAChR binding-site density was demonstrated throughout the HF in the epilepsy specimens compared with autopsy controls and correlated in severity with reductions in cell counts in several HF regions. In contrast to MAChR, VAChT binding-site density was unchanged in the epilepsy specimens compared with autopsy controls. CONCLUSIONS: Reduction in MAChR binding in HS is attributable to intrinsic neuronal losses. Sparing of afferent septal cholinergic terminals is consistent with the hypothesis that an excitotoxic mechanism may contribute to the development of HS and refractory partial epilepsy in humans.

Adult↗
PubMed1998

Characterization of Oct2 from the channel catfish: functional preference for a variant octamer motif.

The Ig heavy chain enhancer of the channel catfish (Ictalurus punctatus) has an unusual position and structure, being found in the 3' region of the mu gene and containing eight functional octamer motifs of consensus (ATGCAAAT) and variant sequences. The presence of multiple octamer motifs suggests that an Oct2 homologue may play an important role in driving expression of the Ig heavy chain locus in a teleost fish. To test this hypothesis, two catfish Oct2 cDNAs (alpha and beta) were cloned by screening a catfish B cell cDNA library. Catfish Oct2 alpha and beta isoforms are derived by alternative RNA splicing; as determined by Southern analysis, Oct2 is a single copy gene. In comparisons with mammalian Oct2, the catfish Oct2 isoforms show high sequence conservation in their N-terminal regions and POU domains, but extensive divergence in their C-terminal regions. Catfish Oct2 a and beta are tissue restricted, bind both consensus and variant octamer motifs, and activate transcription in both catfish and murine cells. In contrast, mouse Oct2 activated transcription in mouse but not catfish cells. Catfish Oct2 beta is a more potent transcriptional activator than Oct2 alpha. In transient expression assays, catfish Oct2 beta showed a marked preference for the octamer variant, ATGtAAAT, which occurs twice in the catfish enhancer. Mouse Oct2 also showed increased activity with the variant octamer when tested in mouse B cells. Gel-shift analysis competition assays indicated that catfish Oct2 binds the consensus octamer motif with an apparently higher affinity than it does the variant motif.

Alternative Splicing↗
PubMed1998

Influence of head trauma on outcome following anterior temporal lobectomy.

BACKGROUND: There is controversy in the literature regarding the importance of risk factors in developing epilepsy and seizure outcome following anterior temporal lobectomy. Some of the existing studies may be biased because of patient selection and limitations in determining predisposition. OBJECTIVE: To investigate the role of risk factors for epilepsy in determining outcome following anterior temporal lobectomy. PATIENTS AND METHODS: We identified 102 patients in a consecutive surgery series for epilepsy from a tertiary center with a minimum of 1-year postoperative follow-up. Risk factors for epilepsy were determined prospectively on at least 3 occasions before anterior temporal lobectomy. Risk factors investigated were a history of febrile convulsions, family history of epilepsy, significant head trauma, history of meningitis, history of encephalitis, or significant perinatal insult. Foreign tissue lesions on magnetic resonance imaging was also included if an anterior temporal lobectomy was performed for presumed dual pathologic findings (hippocampus and lesion). Outcome was determined using Engel's classification. For statistical analysis we used successive logistic regression analysis, chi(2) test, Fisher exact test, and t test. RESULTS: Of the 102 patients, 13 had no identified risk factor for epilepsy, 49 had 1 identified risk factor, and 40 had more than 1. Frequencies were 39 febrile convulsions (15 complex febrile convulsions), 29 head trauma, 22 with lesions seen on magnetic resonance imaging, 12 history of meningitis, 2 history of encephalitis, 19 family history of epilepsy, and 4 perinatal insult. Seventy-one (70%) were classified as Engel's class I, with 56 patients continuously free of seizures at follow-up. Those without risk factor were as likely to be rendered free of seizures following anterior temporal lobectomy as those with a risk factor (P = .27). No risk factor alone or in combination was correlated with complete freedom from seizures following anterior temporal lobectomy, but the presence of head trauma, alone or in combination, was correlated with continued seizures following anterior temporal lobectomy (P = .03; odds ratio, 2.6). Better outcomes were not seen in those with head trauma before the age of 5 years (P = .57). These findings did not change if all those with lesions on magnetic resonance imaging were excluded in the analysis. Those with a history of head trauma were as likely to have pathologic evidence of mesial temporal sclerosis as others (P = .82). CONCLUSIONS: Patients with a history of significant head trauma are less likely to become free of seizures following anterior temporal lobectomy. No other risk factor correlated with a statistically significant greater or lesser chance of freedom from seizures. This information may be used in preoperative counseling of patients.

Adult↗
PubMed1998

Tracheotomy tube occlusion status and aspiration in early postsurgical head and neck cancer patients.

The purpose of the present study was to investigate tracheotomy tube occlusion status and prevalence of aspiration utilizing videofluoroscopy. A prospective study was done of 16 consecutive, early, postsurgical head and neck cancer patients with tracheotomy. Selection criteria included the ability to tolerate tracheotomy tube occlusion prior to and during the modified barium swallow procedure, oral and/or pharyngeal surgical resection, no history of neurological disease or stroke, and medical clearance to begin oral feeding. There was 100% agreement among the independent reviewers on ratings of the presence or absence of aspiration. It was found that occlusion status of the tracheotomy tube did not influence the prevalence of aspiration in the immediate postoperative period. No trends were observed when comparing bolus consistency, type of tracheotomy tube, or presence/absence of a nasogastric tube and the ratings of aspiration.

Adult↗
PubMed1998

Localization of a gene for incomplete X-linked congenital stationary night blindness to the interval between DXS6849 and DXS8023 in Xp11.23.

Congenital stationary night blindness (CSNB) is a nonprogressive retinal disorder characterized by night blindness, nystagmus, myopia, a variable decrease in visual acuity, an abnormal electroretinographic response, and a disturbance in dark adaptation. Two forms of X-linked CSNB have been defined, complete CSNB in which rod function is extinguished, and incomplete CSNB in which rod function is reduced but not extinguished, as seen by electroretinography and dark adaptometry. In studying a large family of Mennonite ancestry, we have confirmed linkage between the locus (CSNB2) for incomplete CSNB and genetic markers in the Xp11 region. In particular, lod scores of 12.25 and 15.26 at zero recombination were observed between CSNB2 and the markers DXS573 and DXS255. Detailed analysis of critical recombinant chromosomes in this extended family have refined the minimal region for the CSNB2 locus to the interval between DXS6849 and DXS8023 in Xp11.23.

Adaptation, Physiological↗
PubMed1998

Soft tissue reconstruction following hemipelvectomy.

BACKGROUND: Resection of primary and metastatic pelvic bone disease may result in large soft tissue deficits. Guidelines for soft tissue reconstruction following pelvic bone resection were evaluated in a retrospective study. METHODS: Over a 5-year period 21 patients (31%) required soft tissue reconstruction following pelvic bone resection. Data on these patients were retrieved from case records. RESULTS: Twelve patients underwent immediate, planned reconstruction, 1 a two-stage reconstruction, and 8 patients required a delayed procedure for complications after bone resection and primary closure. Soft tissue reconstruction was usually accomplished with muscle-based flaps; (25 flaps in 20 patients: 20 pedicled, 5 free), or with skin grafts alone (1 patient). Specific postreconstruction complications occurred in 9 patients, 5 in flaps based on the ipsilateral rectus muscle. CONCLUSION: Flap closure is indicated to achieve primary closure and eliminate deadspace. The ipsilateral rectus muscle should be used with caution and contralateral-based rectus flaps considered. Indications for free flaps include the size and location of the defect and availability of tissue from an amputated limb.

Adult↗
PubMed1998

Skeletal expansion combined with soft-tissue reduction in the treatment of obstructive sleep apnea in children: physiologic results.

Twenty consecutive children, ranging in age from 6 days to 18 years, were treated with skeletal expansion, in addition to soft-tissue reduction, for medically refractory obstructive sleep apnea. The underlying diagnoses were craniofacial microsomia (n = 6), Down syndrome (n = 3), Pierre Robin syndrome (n = 3), cerebral palsy (n = 3), Nager's syndrome (n = 1), Treacher Collins syndrome (n = 1), cri du chat syndrome (n = 1), juvenile rheumatoid arthritis (n = 1), and temporomandibular joint ankylosis (n = 1). Fourteen children had severe medically refractory sleep apnea and were tracheostomy candidates; in the remaining six, tracheostomies were placed shortly after birth and could not be decannulated. Overnight, 12-channel polysomnography was obtained before and after surgery. The mean apnea index improved from 7.42 to 1.26, the mean respiratory disturbance index improved from 25.24 to 1.72, and the mean lowest apnea-related oxygen saturation improved from 68% to 88%. Of the 14 children with medically refractory obstructive sleep apnea, two required tracheostomies. Of the six patients with tracheostomies, five have been decannulated at the time of this writing. Skeletal expansion in conjunction with soft-tissue reduction in the pediatric population permits substantial increases in the volume of both the nasopharynx and oropharynx. Creative use of conventional osteotomies and the application of distraction osteogenesis have enabled surgeons to apply maxillofacial and craniofacial techniques in treating children with obstructive sleep apnea.

Adolescent↗
PubMed1998

Transosseous transposition of a pedicled rectus abdominis flap to cover hip wounds.

Bone-marrow transplantation may be complicated by aseptic necrosis of the femoral head. Prolonged immunosuppression places the patient at increased risk of infection and is of particular concern if replacement arthroplasty is contemplated. Infection of a prosthesis usually requires thorough debridement and removal of the device. However, attention must also be paid to the resultant cavity and soft-tissue cover. Several flaps have been reported for this problem, though limitations of flap size may make it difficult to achieve both objectives. This report describes the use a pedicled rectus abdominis flap that was tunnelled through the acetabulum in order to gain direct access to the hip and allow adequate length both to fill the dead-space and to provide cover.

Adult↗
PubMed1998

Effect of dietary vitamin A or N-acetylcysteine on ethylnitrosourea-induced rat gliomas.

It is our hypothesis that low grade gliomas are the glial counterparts of other precancerous lesions such as colon polyps and, therefore, suitable targets for chemoprevention. Steps in the molecular progression of gliomas have been described, indicating that an accumulation of abnormalities is required for progression to a high grade and interruption of this progression might be possible. An animal model of chemical glial carcinogenesis was used to test this hypothesis. Pregnant rats were injected intravenously with ENU (ethylnitrosourea) on the 18th day of gestation to induce gliomas in the offspring, which were randomized to receive control diet, diet supplemented with vitamin A palmitate, or diet supplemented with N-acetylcysteine. Animals exposed to ENU and receiving a control diet developed brain tumors and had a shortened life expectancy compared with rats unexposed to ENU. The animals treated with NAC showed no statistically significant delay in the time to tumor and no change in the histologic grade of the tumors when compared with animals receiving control diet, but the time to death from any cause of NAC treated animals differed significantly from untreated animals. Animals receiving high dose VA had statistically significantly prolonged time to tumor, survived significantly longer than untreated animals, but had no reduction in the total number of tumors or change in the histologic grade of their tumors. The theoretical basis of these results is likely due to the putative mechanism of action of these agents. These data indicate that glioma chemoprevention is possible and deserves further exploration.

Acetylcysteine↗
PubMed1998

Expression of c-myc oncoprotein represents a new prognostic marker in cutaneous melanoma.

BACKGROUND: Overexpression of the c-myc oncoprotein has been observed to be of prognostic significance in several human cancers. This study was undertaken to establish whether c-myc has any prognostic significance in melanoma. METHODS: Expression of c-myc oncoprotein was studied in a prospective series of primary and secondary malignant melanomas. Ethanol-fixed tissue was digested into nuclei and stained for flow cytometric analysis using a pan-myc antibody. RESULTS: Overexpression of the c-myc oncoprotein was prevalent in both disease stages. In primary disease, overexpression was associated with tumour thickness and with the presence of ulceration, age and reduced disease-free interval. Of most importance, high expression of c-myc predicted poor outcome in both primary and metastatic disease. In addition, c-myc was able to discriminate prognosis in melanomas uniformly stratified as thick (greater than 3 mm) lesions. CONCLUSION: These results indicate an important role for c-myc in melanoma which may lead to better prognostic information and identification of new therapeutic strategies.

Adult↗
PubMed1998

Dietary selenium supplementation is required to support full expression of three selenium-dependent glutathione peroxidases in various tissues of weanling pigs.

The current dietary allowance for selenium (Se) for pigs does not consider Se requirements for expression of several newly discovered Se-dependent enzymes and has raised environmental concerns. Our objective was to determine dietary Se requirements of young pigs for the full expression of cellular (GPX1), plasma (GPX3) and phospholipid hydroperoxide (GPX4) glutathione peroxidases. In Experiment 1, 18 weanling male pigs (4 wk old) were fed a corn-soybean meal basal diet (BD, 0.03 mg Se/kg) with the addition of 0, 0.1 or 0.3 mg Se/kg (Na2SeO3). In Experiment 2, 24 weanling barrows (6 wk old) were fed a similar BD with the addition of 0, 0.2, 0.3 or 0.5 mg Se/kg. Both experiments lasted for 5 wk. Pigs fed the BD had lower (P < 0.05) tissue GPX1 and GPX4 activities, plasma GPX activity, and(or) plasma Se concentrations than those fed the Se-supplemented diets. In Experiment 1, GPX1 and GPX4 activities in liver, heart and lung were lower (P < 0.05) in pigs fed 0.1 mg Se/kg than in those fed 0.3 mg Se/kg, although no such differences existed in thyroid or pituitary. Pigs fed 0.1 mg Se/kg also had lower (P < 0.05) plasma GPX3 activity at wk 5 and higher (P < 0.05) hepatic glutathione S-transferase activity than pigs fed 0.3 mg Se/kg. In Experiment 2, GPX1 and GPX4 activities in liver and heart, GPX1 and GPX4 mRNA levels in liver and GPX3 activity in plasma exhibited plateaus at 0.2 mg Se/kg. Pigs fed the BD had greater concentrations of F2-isoprostanes (a marker of in vivo lipid peroxidation) than those fed 0.2 mg Se/kg in plasma (P < 0.03) and liver (P < 0.04). We conclude that supplemental Se at 0.2 mg Se/kg of diet is required to support the full expression of three Se-dependent glutathione peroxidases in young pigs.

Animals↗
PubMed1998

Cellular glutathione peroxidase is the mediator of body selenium to protect against paraquat lethality in transgenic mice.

The antioxidative role of Se-dependent cellular glutathione peroxidase (EC 1.11.1.9, GPX1) in vivo has not been established. Our objective was to determine the effects of GPX1 knockout or overexpression on the susceptibility of mice to paraquat toxicity and the contributions of GPX1, compared with other selenoproteins and vitamin E, to body defenses against such acute oxidative stress. Four experiments were conducted using 111 GPX1 knockout or overexpressing mice and the respective controls. Mice were fed diets supplemented with Se (as sodium selenite) at 0-0.4 mg/kg and/or all-rac-alpha-tocopheryl acetate at 0-75 mg/kg before intraperitoneal injections of 12.5, 50 or 125 mg paraquat/kg body weight. All mice that received 50 or 125 mg paraquat/kg died spontaneously, and the survival time of mice was (independent of dietary levels of Se per se or alpha-tocopheryl acetate) solely a function of tissue GPX1 activity (P < 0.001). Severe acute pulmonary interstitial necrosis was found only in the GPX1 overexpressing mice and the controls that had extended survival time. Thiobarbituric acid reacting substances in postmortem liver inversely correlated with the tissue GPX1 activity and dietary levels of Se and/or alpha-tocopheryl acetate. In contrast, all mice that received 12.5 mg paraquat/kg survived and were killed 2 wk after the injection for tissue collection. Compared with the saline injection, this low dose of paraquat resulted in greater (P < 0.001) liver and lung F2-isoprostanes in both the GPX1 knockout mice and the controls. However, there was no difference in plasma alanine transaminase (EC 2.6.1.2) activity or overt injuries in liver, lung and kidney in either group. Our data indicate that GPX1 is the major, if not the only, metabolic form of body Se that protects mice against the lethal oxidative stress caused by high levels of paraquat; it seems less important, however, in protecting mice against the moderate oxidative stress by the low level of paraquat.

Animals↗
PubMed1998

Laparoscopic harvesting of jejunal free flaps for esophageal reconstruction.

Endoscopic harvest of the jejunum is indicated for the reconstruction of complex defects of the head and neck and specifically the reconstruction of circumferential defects of the esophagus. However, open laparotomies are associated with systemic and local morbidity and are often seen as prohibitively invasive procedures. Laparoscopy for intra-abdominal procedures is a proven technique that yields less morbidity and provides an anatomical exposure similar to that of the open approach. We report on 11 consecutive clinical cases of free jejunal flap harvesting with the laparoscopic technique and show that the procedure is feasible.

Adult↗
PubMed1998

Evolutionary variation of immunoglobulin mu heavy chain RNA processing pathways: origins, effects, and implications.

Immunoglobulins (Ig) can occur in two physical forms, soluble (secreted) and membrane bound. The soluble form is secreted from B cells, and is present in the blood and other fluids where it plays a role as an immune effector molecule. The membrane-bound form of the Ig molecule is inserted into the B-cell membrane, where it serves as a receptor for antigen. The function of the membrane-bound Ig as a receptor for antigen requires additional accessory molecules, the membrane Ig plus accessory molecules are referred to, collectively, as the B-cell receptor (BCR) complex. The secreted and membrane-bound forms of an Ig result from alternative patterns of RNA processing of the primary transcript from the heavy chain gene. IgM is the only class of Ig known to be conserved in all vertebrate species (perhaps exclusive of the agnathan fish). While the structure of the IgM heavy (mu) chain gene has been highly conserved in vertebrate evolution, the patterns of alternative RNA processing of the mu transcript show surprising diversity. In particular, the bony fish (teleosts) produce membrane mu-chain message by a splicing pathway that is quite different from that seen in other vertebrates; it results in the production of membrane IgM that lacks the C mu 4 domain. How this unusual RNA splicing pattern could have evolved and its implications for the function of the BCR in the bony fishes are considered here.

Animals↗
PubMed1998

Cleidocranial dysostosis--a case report and review of the literature.

Cleidocranial dysostosis is a generalised dysplasia of bone and teeth with predominantly autosomal dominant inheritance. A new case referred to the Paediatric Department at the British Military Hospital, Rinteln is reported and a review of the literature discussed.

Child, Preschool↗
PubMed1998

Social characteristics and their importance in reducing inequalities in health in the Armed Forces.

OBJECTIVES: To investigate whether there was a difference in social characteristics in different garrison towns of the British Forces Germany and to ascertain whether the health visitor workload was different in these towns. DESIGN: Self completed questionnaires administered to mothers by health visitors on first contact after delivery of their baby, and prospective follow up by health visitors recording subsequent contacts for the first three months after birth. SETTING: 97 mothers based in Bruggen, Fallingbostel and Rheindahlen who had just delivered their new-born baby. RESULTS: Response rates for Bruggen, Fallingbostel and Rheindahlen were 54.8%, 70.2% and 69.9% respectively. There was a significant difference between parents in Fallingbostel and Rheindahlen with higher levels of maternal smoking during pregnancy (p = 0.04), more fathers aged under 25 years (p = 0.004), lower paternal military rank (p = 0.003), and increased paternal absence of more than one month during the pregnancy (p = 0.001) in Fallingbostel. The characteristics in Bruggen were similar to those in Rheindahlen. The workload of the health visitors, was significantly increased in Fallingbostel in comparison to Rheindahlen (p = 0.003). CONCLUSION: The use of social characteristics as an assessment of need would allow appropriate targeted health promotion and education resulting in a reduction in the inequalities of health in the Armed Forces.

Adult↗