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Biomedical subjects

D Butler

Publications and source records attributed to D Butler.

At least 361 records · Page 20Linked to original sources
PubMed1989

Synchronous intrauterine and ectopic pregnancy associated with clomiphene citrate.

Although synchronous intrauterine and ectopic pregnancies associated with the use of clomiphene citrate for infertility are rare, the actual incidence might, in fact, be considerably higher than previously thought. The cornerstone for ruling out an extrauterine gestation is the presence of sonographic evidence of an intrauterine pregnancy, as the possibility of concomitant intrauterine and extrauterine gestation is perceived to be statistically rare. This has resulted in an unacceptably high incidence of negative ultrasound interpretations. During a recent 12 month period, four women treated with clomiphene citrate for infertility were diagnosed as having concomitant intrauterine and ectopic pregnancies. Three had pelvic sonograms that were erroneous for the extrauterine component. However, successful evacuation of the products of ectopic gestation was performed in each, despite an immediate preoperative false-negative ultrasound report. Three of the women delivered healthy normal infants at full term, and the fourth woman spontaneously aborted the products of the concomitant intrauterine gestation. All four did well postoperatively, and no gross complications were encountered. Reassessment of ultrasound diagnostic criteria and the use of more sensitive methods, such as endovaginal ultrasound in high risk patients, are indicated for any symptomatic patient using clomiphene citrate for infertility. Awareness of the prevalence of this entity and the limitations of ultrasound will lead to prompt intervention and improved survival rates.

Clomiphene↗
PubMed1987

Efficient Tn10 transposition into a DNA insertion hot spot in vivo requires the 5-methyl groups of symmetrically disposed thymines within the hot-spot consensus sequence.

Transposon Tn10 inserts preferentially at particular insertion "hot spots" that share a symmetrical 6-base-pair consensus sequence: 5' GCTNAGC 3'. The protein that recognizes this sequence is not known but is likely to be the Tn10-encoded transposase protein. We present evidence that the 5-methyl groups of the two thymines in this sequence are essential for efficient transposon insertion; in their absence the sequence is still recognized, but at lower efficiency. We have reached this conclusion by examination of a specific hot spot whose sequence is 5' GCCAGGC 3'. The innermost cytosines of this sequence happen to be substrates for methylation at their 5 positions by the bacterial dcm-encoded methylase. We find that Tn10 transposes into this site 15 times more frequently in a Dcm+ host than in a Dcm- host; in the Dcm- host, insertions still occur, but at a low frequency. Thus, at this site, the absence of pyrimidine 5-methyl groups at the third positions of the consensus sequence is sufficient to convert a strong insertion hot spot into a weaker but still recognizable hot spot. This observation supports the general proposition, suggested previously by comparisons among consensus sequences, that the presence or absence of these 5-methyl groups is one major feature that can make the difference between a strong and a weak Tn10 insertion hot spot.

Base Sequence↗
PubMed1987

Superinfection of a chimpanzee with a second strain of human immunodeficiency virus.

Two chimpanzees, one (C-499) infected with the acquired immunodeficiency syndrome-associated retrovirus type 2 (ARV-2) strain of human immunodeficiency virus (HIV) and one (C-560) infected with the lymphadenopathy-associated virus type 1 (LAV-1) strain of HIV, were inoculated with approximately 10(4) tissue culture infective doses of the reciprocal strain. At the time of the second inoculation, both chimpanzees had high titers of HIV-specific antibodies, including antibodies that neutralized both virus strains. After inoculation of the second strain of HIV, the antibody titers in both chimpanzees increased 4- to 10-fold, and in one chimpanzee (C-499), the numbers of infectious peripheral blood mononuclear cells (PBMC) increased 1,000-fold to levels that are comparable with those observed after primary HIV infections. By restriction enzyme analysis of virus recovered from PBMC, both ARV-2 and LAV-1 were identified in C-499, thus demonstrating that superinfection had occurred.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Transfusion-associated AIDS: donor-recipient human immunodeficiency virus exhibits genetic heterogeneity.

The genetic diversity of the human immunodeficiency virus (HIV) isolated from transfusion-associated AIDS patients has been examined. Restriction enzyme mapping studies of integrated proviral DNA of donor and recipient origin demonstrated genomic variation between isolates. Analysis of the molecularly cloned viral genomes of one donor-recipient pair showed that virus from the recipient had restriction enzyme site differences from the donor, noticeably clustered in the env and orf-2 regions, and also had a greater number of restriction sites in common with the donor as well. These results suggest that HIV may undergo genomic variation in vivo. Comparison of donor-recipient viruses may further the understanding of the molecular basis for AIDS pathogenesis.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Penicillamine-induced exacerbation of rheumatoid arthritis.

We have described three patients whose rheumatoid arthritis was exacerbated by penicillamine. The exacerbation was manifested as severe, disabling, febrile, symmetric polysynovitis with normocomplementemia, negative ANA, and reversibility upon discontinuance of the drug. The pathogenesis is yet to be determined.

Acute Disease↗
PubMed1985

Recognition of malleus handle fracture in the differential diagnosis of otologic trauma.

We have had the opportunity to care for four patients who experienced barotrauma or implosive trauma to their ears. The differential diagnosis in these cases included ossicular injuries as well as possible perilymph fistulae. In each of these cases there was a small conductive hearing loss which fluctuated and a high compliance tympanogram. Careful otoscopy with the aid of pneumomassage revealed an isolated malleus handle (manubrium) fracture. Exploration of one ear was performed to rule out perilymph fistula and the diagnosis of malleus handle fracture was confirmed. Recognition of this injury preoperatively in these three other patients made exploration unnecessary. While injuries to the ossicular chain have been well-described in the literature, isolated malleus handle fracture has not been previously reported.

Acoustic Impedance Tests↗
PubMed1984

Auer rods in mature granulocytes: a unique morphologic feature of acute myelogenous leukemia with maturation.

The authors observed Auer rods in mature neutrophils, bands, and metamyelocytes in two children with AML with maturation (FAB M2). In order to determine if this rare finding was characteristic of AML M2, the authors reviewed the bone marrows and peripheral blood smears of 50 children with AML M2 and 50 children with other AML subtypes (FAB M1, M3, M4, and M5). They found Auer rods in mature neutrophils and band forms in 10 of 50 patients (20%) with AML M2 but in none of 50 patients with non-M2 AML. This finding was not related to the frequency of mature cells in the specimen or to the frequency of Auer rods in blasts. Cytogenetics did not show a consistent abnormality. The presence of Auer rods in mature granulocytes is unique to FAB M2 AML in the authors' series and supports the concept that in AML at least some of the mature myeloid cells are involved in the leukemic process.

Adolescent↗
PubMed1983

Granular acute lymphoblastic leukemia.

Granules in blasts are most typical of acute myeloblastic leukemia. However, there have been scattered reports of patients with acute lymphoblastic leukemia (ALL) that have lymphoblasts with azurophilic cytoplasmic granules. These reports do not describe immunologic markers or cytogenetics. We report five additional cases with detailed cytologic, immunologic, and cytogenetic studies. At diagnosis one of these patients had central nervous system disease, while the others had no unusual features. Four of the five patients attained remission. The blasts of all five patients contained distinct cytoplasmic azurophilic granules. The granules were negative for peroxidase and chloroacetate esterase and positive for PAS, acid phosphatase, alpha-naphthyl acetate esterase incompletely fluoride inhibited, alpha-naphthyl butyrate esterase, and in one case, Sudan black B. In the one patient studied by electron microscopy, characteristic lymphoblasts contained membrane-bound electron lucent inclusions, which stained positively with non-specific esterase. Immunologic markers showed a common ALL phenotype. Different cytogenetic abnormalities were seen in all cases. It is important to recognize the characteristics of this morphologic subtype of ALL in order to avoid a misdiagnosis of acute nonlymphocytic leukemia.

Adolescent↗
PubMed1983

Absence of cardiac arrhythmias during a very-low-calorie diet with high biological quality protein.

Fourteen women who were at least 50 lb (22.7 kg) overweight entered the 15 week study which included 4 weeks of 1200 cal (5028 J) balanced diet followed by 7 weeks on a very-low-calorie diet (VLCD) and 4 weeks of refeeding. During the VLCD high biological quality protein (poultry, fish) and recommended supplements of vitamins, minerals and water were used. With the exception of week 5 and 14, 25-h Holter monitorings were done weekly. During the initial 4 weeks, 2 patients showed disturbances of cardiac rhythm and were discharged from the study. Twelve patients completed the trial without any clinically significant changes in cardiac rhythm. The 12 lead ECGs remained normal in all patients throughout the study. The average weight loss was 46 lb (20.9 kg) and the whole program was well tolerated. It is concluded that seven weeks of VLCD with high biological quality protein and recommended supplements appears to be a safe method for weight reduction for severely obese patients.

Adult↗
PubMed1981

An evaluation of a ward pharmacy service.

An evaluation of a ward pharmacy service showed: 1. Its introduction led to a 40-50% reduction in errors and ambiguities of prescribing. 2. It assisted in the safe and more effective use of medicines in hospitals. 3. Medical staff particularly valued the safety checking applied to their prescriptions and the patient's total medication profile, and the opportunity of seeking information about drugs. Nursing staff most appreciated the checking and clarifying elements which assisted during the administration of drugs, the promotion of the most effective use of medicines and the opportunity of discussing problems of drug therapy.

Drug Prescriptions↗