Patients can be pain-free while undergoing implanted port assessment.
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Anesthetics, Local↗
Biomedical subjects
D Baldwin
Publications and source records attributed to D Baldwin.
Hyperparathyroidism and pancreatitis during pregnancy.
Although the simultaneous occurrence of hyperparathyroidism and pancreatitis during pregnancy is rare, several points should be emphasized. Early recognition and treatment are essential. Pancreatitis should be kept in the differential diagnosis of unexplained nausea, vomiting, and abdominal pain during pregnancy. Hyperparathyroidism should always be included in the differential diagnosis of pancreatitis. Finally, the second trimester is the optimal period for surgical intervention.
Adult↗
Laser-Doppler blood flowmetry measurement of nasal mucosa blood flow after injection of the greater palatine canal.
Laser-Doppler blood flowmetry was used to measure the mucosal blood flow of the inferior turbinate before and after injection of the greater palatine canal with 2 ml of a 0.5 per cent bupivicaine hydrochloride solution. Injection of the greater palatine canal is a useful technique in the control of posterior epistaxis. The arterial blood supply to the inferior turbinate is via a single descending branch of the sphenopalatine artery. We conjectured that injection of the pterygopalatine fossa, via the greater palatine canal, would result in a reduction of blood flow to the inferior turbinate. In this study injection of the pterygopalatine fossa caused only a 4.7 per cent decrease in blood flow to the inferior turbinate mucosa (p = 0.571). Elevation of the head by an angle of 20 degrees reduced nasal mucosal blood flow by 38.3 per cent (p < 0.0001). Depression of the head by an angle of 20 degrees increased nasal mucosal blood flow by 74.7 per cent (p < 0.0001). We conclude that there is an adequate collateral blood circulation to the anterior portion of the inferior turbinate.
Adult↗
Experimental D-penicillamine-induced myopathy.
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Analysis of Variance↗
Glutathione S-transferase GSTT1 genotypes and susceptibility to cancer: studies of interactions with GSTM1 in lung, oral, gastric and colorectal cancers.
Allelism in glutathione S-transferase GSTM1 and GSTT1 has been suggested as a risk factor in various cancers. Accordingly, we describe a group of case-control studies carried out to identify associations between GSTT1 genotypes and susceptibility to lung, oral, gastric and colorectal cancers. The frequencies of the putatively high risk GSTT1 null genotype were not increased in the lung, oral or gastric cancer cases compared with controls but the frequency of this genotype was significantly increased (P = 0.0011, odds ratio = 1.88) in the colorectal cancer cases. No significant interactions between the GSTT1 and GSTM1 null genotypes types were identified in the cancer groups studied. Indeed, no significant associations between GSTM1 genotypes and susceptibility were identified though further evidence was obtained that the protective effect of GSTM1*A and GSTM1*B is not equal. The data complement studies showing that GSTT1 null is associated with an increased susceptibility to total ulcerative colitis and suggests that this enzyme is important in the detoxification of unidentified xenobiotics in the large intestine.
Case-Control Studies↗
Development and validation of a nonisotopic immunoassay for the detection of LSD in human urine.
A microplate enzyme immunoassay (EIA) for the detection of lysergic acid diethylamide (LSD) in human urine was developed. The assay kit is designed around an LSD derivative coated on the wall of microplate wells with preservatives and stabilizers. Sample and rabbit anti-LSD are added to the microplate well. The immobilized LSD and LSD present in specimens compete for the opportunity to bind to the anti-LSD antibodies. An anti-rabbit antibody labeled with horseradish peroxidase is used to provide the assay signal, which is inversely proportional to the concentration of LSD in the sample. The assay requires a 25-microL urine sample and three consecutive incubation periods of 60, 30, and 30 min at room temperature. The assay was tested with a variety of drugs, including ergot alkaloids spiked into drug-free urine at up to 100,000 ng/mL without cross-reaction. Nor-LSD was shown to cross-react between 16% and 28%, depending on its concentration. Of the other compounds tested, only ergonovine demonstrated slight cross-reactivity at approximately 0.0008%. The assay is designed to be used with a qualitative cutoff of 0.5 ng/mL. Precision testing at 0.5 ng/mL gave a coefficient of variation (CV) of 6% based on 20 replicates. The CV at 0.375 ng/mL (cutoff, -25%) was 5.2% and at 0.625 ng/mL was 6.6%. Precision at other concentrations within the range of the calibration curve gave similar results both intra- and interassay. Clinical performance of the assay was compared with that of a commercial radioimmunoassay (RIA). Comparable performance was observed with both methods, each screening a total of 458 samples as negative and 17 samples as positive relative to a 0.5 ng/mL cutoff. The EIA found an additional three positive samples that were negative by RIA. The EIA is suitable for the screening of urine samples for the presence of LSD. Preliminary indications are that the assay is also suitable for use with whole blood specimens. The assay can be performed manually or be fully automated and without the need for radioactivity; it can be used in any laboratory.
Absorption↗
A model for describing low-income African American women's participation in breast and cervical cancer early detection and screening.
The article reports on data derived from two investigations. In one study, focus groups were used with low-income African American women to pilot test a teaching module developed to support the inclusion of culturally relevant content on breast and cervical health in teaching low-income African American women. A second study using individual interviews was undertaken to illuminate the lived experience of low-income African American women who participated in breast and cervical cancer early detection and screening services. Data analysis of group and individual interviews were performed using phenomenology as a methodological approach. Findings from the two studies, combined with information identified in the theoretical and literary contexts, supported the development of an Afrocentric model that describes the lived experience and decision making practices of low-income African American women's participation in breast and cervical cancer early detection and screening services.
Adolescent↗
Cardiopulmonary support mitigates the effects of experimental myocardial ischemia.
The effectiveness of cardiopulmonary support (CPS) as a rescue method following failed angioplasty is unknown. The proximal left anterior descending (LAD) was occluded for 20 min in 21 dogs. Group 1 animals (n=15) were given CPS and group 2 animals (n=6) served as controls. During coronary occlusion, animals receiving CPS had increased mean arterial pressure (71+/- 12 vs 58+/-7 mm Hg), decreased left atrial pressure (3+/-3 vs 12+/-3 mm Hg), increased ischemic area blood flow (0.20+/-0.16 vs 0.02+/-0.04 mL/min/g) and myocardial oxygen consumption (0.014+/- 0.008 vs 0.003+/-0.006 mL O2/min/g), decreased remote area myocardial oxygen consumption (0.026+/-0.010 vs 0.091+/-0.047 mL O2/min/g), and an improved myocardial oxygen consumption index (0.60+/-0.33 vs 0.02+/-0.03) when compared with controls (p<0.05). During reperfusion (no CPS), group 1 animals had increased cardiac index (210+/-95 vs 117+/-46 mL/min/kg), renal blood flow (110+/-38% vs 53+/-45%), ischemic area blood flow (1.13+/-0.40 vs 0.58+/-0.27), and myocardial oxygen consumption (0.066+/-0.015 vs 0.032+/-0.018) when compared with controls (p<0.05). CPS improves oxidative metabolism in selective myocardial segments during coronary occlusion, promotes recovery of the postischemic myocardium, and results in improved peripheral circulation.
Angioplasty, Balloon, Coronary↗
Invasion of privacy? Writing the biography of Mona Wilson.
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Biographies as Topic↗
Surgery for pharyngeal pouch: audit of management with short- and long-term follow-up.
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Aged↗
Temporal changes in function and regional glucose uptake within stunned porcine myocardium.
UNLABELLED: This study compared the effects of porcine myocardial stunning on the uptake of [18F]-fluorodeoxyglucose (FDG) at 24 hr and 7 days after reperfusion. Prior studies in animals subjected to severe myocardial ischemia have shown a sustained increase in FDG uptake relative to perfusion (FDG/MBF). The time course of recovery of FDG/MBF relative to function poststunning, however, has not been well characterized. METHODS: Stunning was induced in eight swine by partially occluding the LAD artery for 20 min. At 1 and 7 days postreperfusion, function was assessed by two-dimensional echocardiography and PET studies were obtained with FDG and either 15O-water or 13N-ammonia. Blood flow by microspheres was determined at baseline, during ischemia and after stunning. Myocardial uptake of FDG relative to blood flow on matching images (FDG/MBF) was calculated for all ROIs and expressed as a ratio of LAD to non-LAD areas. RESULTS: After stunning, left ventricular ejection fraction (LVEF) increased from 42% +/- 10% on Day 1 to 52% +/- 6% on Day 7 (p < 0.05). At Day 1, myocardial blood flow was 0.60 +/- 0.10 ml/min/g in LAD and 0.67 +/- 0.16 in non-LAD regions and neither differed at Day 7. The magnitude of FDG/MBF in the LAD region when normalized to the non-LAD region was 1.29 +/- 0.16 on Day 1 and 1.09 +/- 0.08 on Day 7 (p < 0.05) and was inversely proportional to global measures of LVEF (r2 = 0.61; p < 0.005). CONCLUSION: The severity of postischemic LV dysfunction at 1 and 7 days after stunning correlates with the degree of enhanced regional glucose uptake as estimated by PET. Both normalize within 7 days, suggesting that metabolic and functional abnormalities within completely reperfused myocardium recover in parallel.
Animals↗
Hepatitis C seroprevalence amongst injecting drug users attending a methadone programme.
AIM: To study the seroprevalence of the hepatitis C virus (HCV) amongst a population of injecting drug users and to examine the relationship between potential risk factors and HCV infection. METHODS: A sample of 116 clients attending a methadone treatment clinic in Christchurch took part in this study. Blood samples were analysed to detect antibodies to HCV and to test for HCV RNA: Serum transaminases were also measured. In addition a short questionnaire about sexual behaviour and drug use practices was self completed by all participants in strictest confidence. RESULTS: Slightly more than half the sample were female (54.3%) and most were of European origin (90.6%). The average age was 31.56 years and the average length of time they had been injecting drugs was 9.54 years. HCV antibodies were detected in 84.2% of the sample and HCV RNA in 66.1% of the sample including 75.9% amongst those who were anti-HCV positive and 16.6% amongst those who were anti-HCV negative. AST and ALT levels were elevated amongst 16.8% and 46.2% of the sample respectively. The likelihood of being anti-HCV positive increased with years of drug use and with increased sharing of injecting equipment. No significant relationship between HCV status and sexual practices was evident. Data on the history of drug using practices indicated that sharing of injecting equipment had become less common over time and access to new equipment through reliable sources had become more common with time. CONCLUSIONS: HCV is widespread amongst this population of injecting drug users suggesting the possibility of a major clinical and social problem. Despite evidence of a reduction in the sharing of injecting equipment, HCV transmission is still occurring indicating the potential for other parenterally transmitted diseases, such as HIV, to become established amongst injecting drug users. Those at high risk of HCV should be discouraged from donating blood because of the possibility of HCV seronegative infectivity.
Adult↗
A randomised controlled study of close monitoring of vulnerable psychiatric patients.
The care programme approach was introduced in mental health services in the UK in 1991. It was intended to improve the quality of care and prevent patients losing contact with care services and, by implication, to reduce psychiatric admissions. We did a study to find out if the approach worked. 400 patients from a London inner-city area who had been identified as psychiatrically vulnerable and included on a case register of patients with special needs were randomised into two groups of 200 each. One group received close supervision by nominated key-workers (as recommended in the care programme approach of the UK Department of Health), and the other received standard follow-up from psychiatric and social services. Outcome was recorded after eighteen months. Data on 393 patients was available for analysis. Of 197 patients allocated to standard care, 64 (32.5%) were lost to follow-up compared with 40 (20.4%) of 196 patients receiving close supervision (p = < 0.005). However, patients under close supervision had significantly more admissions (30% vs 18%, chi 2 = 7.61, p < 0.01) and spent 68% more days in hospital than the standard group. The findings of greater hospital-bed use, which differ from those of studies with community-based psychiatric teams, suggest that close supervision by a single key worker, as recommended in the care programme approach, will lead to greater success in maintaining contact with vulnerable patients, but is likely to lead to more psychiatric admissions.
Adult↗
Copper-associated liver disease in childhood.
BACKGROUND/AIMS: Indian childhood cirrhosis is associated with high liver copper concentrations and progressive liver disease with a high mortality. Early treatment with penicillamine was found to reduce mortality and reverse liver damage. We aimed to define the clinical features of copper-associated liver disease outwith the Indian subcontinent and encourage the earlier consideration of the syndrome in cryptogenic liver disease. METHODS: Three European children presented between 10 and 29 months of age with abdominal distension, pyrexia and hepatosplenomegaly. Over 1-5 weeks their condition deteriorated rapidly due to liver failure. Two died within 2 months of onset and one received a successful liver transplant. In two cases consideration of the diagnosis occurred only on examination of the liver after orthotopic liver transplant or death. Light microscopy was used, with haematoxylin and eosin, reticulin and orcein stains. Tissue, plasma and water copper levels were measured by flame atomic absorption spectrometry. RESULTS: All had micronodular cirrhosis and severe hepatocellular necrosis with Mallory bodies and copious-orcein positive material. Liver copper concentrations ranged from 1100-1310 micrograms/g dry weight. For two patients domestic water with high copper content had been used for the preparation of feeds. No environmental source of excess copper could be identified in the third case. CONCLUSIONS: We suggest that the above condition, which is called Indian childhood cirrhosis in the Indian subcontinent and Copper Storage Disease elsewhere, would be better named 'Copper-Associated Liver Disease in Childhood', emphasising the need to consider this disorder in unexplained liver disease and to seek possible sources of excessive copper intake.
Child, Preschool↗
Provox valve use for post-laryngectomy voice rehabilitation.
The Provox voice prosthesis has been used in our department since September 1992 for post-laryngectomy voice rehabilitation. This prosthesis is an indwelling low-resistance tracheoesophageal valve. The cohort consisted of 28 laryngectomes with a mean follow-up time of 352 days. The average valve life before failure was 148 days. Speech intelligibility of 85 per cent was achieved for complete sentences. No major surgical problems were associated with the valve insertion or its use. Replacement of the prosthesis as an outpatient procedure was accomplished without difficulty.
Adult↗
The role of serotonin in depression and anxiety.
Although many serotonin (5-hydroxytryptamine; 5-HT) receptors have been identified, our knowledge of many of the subtypes is limited. However, we do know that 5-HT1A agonists are involved in the treatment of certain anxiety disorders, that 5-HT1C and 5-HT2 receptor antagonists may be indicated for the treatment of generalized anxiety disorder, and that 5-HT1D receptor agonists are used in the treatment of migraine. Recent research has identified that various abnormalities in serotonergic function are involved in the pathogenesis of depression and anxiety, and has facilitated the development of new pharmacological agents with great therapeutic potential, for example the selective serotonin reuptake inhibitors (SSRIs). These agents appear to be effective in the treatment of many anxiety states and may have greater efficacy than other agents in the treatment of certain affective disorders. As the central serotonergic system continues to be "mapped", newer and more selective drugs are likely to be introduced, thereby possibly improving the overall successful management of depression and anxiety disorders.
Anxiety Disorders↗
Effect of diuretics on allergen-induced contractions of passively sensitized human bronchi in vitro.
Inhaled furosemide has been shown to protect subjects with asthma from bronchoconstriction induced by a wide variety of stimuli, including allergen, but the mechanism of action is controversial. We have used an in vitro model of allergen-induced bronchoconstriction to examine the effects of furosemide and other ion transport inhibitors. Human bronchial rings were passively sensitized by incubation with serum from an atopic donor and were challenged with Dermatophagoides pteronyssinus. Allergen-challenged bronchial rings developed bronchoconstriction which was effectively inhibited by the cysteinyl-leukotriene antagonist ICI 198,615 (10(-7) M) and to a lesser extent by terfenadine (10(-5) M). Assessed over 60 min furosemide 10(-6), 10(-5), and 10(-4) M inhibited contractions by a mean (95% confidence interval [CI]) 7.9% (-23.5, 39.3%, p > 0.05), 44.2% (12.9, 75.2%, p < 0.01), and 86.9% (55.5, 118.3%, p < 0.001) respectively (n = 5). The same concentrations of bumetanide inhibited contractions by 21.5% (-8.4, 51.4%, p > 0.05), 13.6% (-16.3, 43.4%, p > 0.05) and 51.6% (21.7, 81.4%, p < 0.01) respectively (n = 5). The sodium transport inhibitor amiloride and the anion transport inhibitor 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS) were without effect (both 10(-4) M; n = 4). Furosemide increased PGE2 production by the bronchial rings by 134% (95% CI 53, 259%). Indomethacin (3 x 10(-6) M) blocked the furosemide-induced increase in PGE2 production and reduced the protection afforded by 10(-4) M furosemide against allergen-induced contractions from 67.9% to 34.7% (mean difference 33.2%; 95% CI 9.7, 56.6%; p < 0.01; n = 8).(ABSTRACT TRUNCATED AT 250 WORDS)
Allergens↗
Immunocytochemical localization of multiple cholecystokinin-like peptides in the stomatogastric nervous system of the crab Cancer borealis.
Three anti-cholecystokinin antibodies were used to label the stomatogastric nervous system of the crab Cancer borealis. Labeled tissues were examined as whole mounts using laser scanning confocal microscopy. Although each of the anti-cholecystokinin antibodies labeled a variety of structures within the stomatogastric nervous system (including somata, fibers and neuropil), the pattern of labeling produced by each antibody was distinct. These results indicate that there is a family of cholecystokinin-like molecules that are differentially distributed among a subpopulation of the neurons in the stomatogastric nervous system of Cancer borealis.
Animals↗