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Biomedical subjects

D Carr

Publications and source records attributed to D Carr.

At least 73 records · Page 4Linked to original sources
PubMed1991

Trigeminal facial pain: a model of peptides and monoamines in intracerebral cerebrospinal fluid.

A biochemical model of chronic trigeminal facial pain with elevated substance P (SP) and co-dysfunctional dopamine (DA), norepinephrine (NE) and purinergic systems is proposed. The serotonergic system is hypoactive as judged by low 5 hydroxyindoleacetic acid (5HIM). In distinction, intracerebral opioids may not be dysfunctional in facial pain as measured by normal levels of beta endorphin (BE). The neuropeptides somatostatin (SOM), cholecystokinin (CCK), met and leu-enkephalin (MENK, LENK) have very small picogram concentrations in these pain patients, but no definite conclusion can be reached on their role in trigeminal pain, alone or with monoamines, because of the small numbers, both sample size and concentrations. Interpretive obstacles to such human neurochemical studies suggest that future work might move to human clinical trials comodulating SP down, inhibitory peptides (SOM, CCK) up, and enhancing monoamine systems.

Biogenic Monoamines↗
PubMed1990

Characteristics of an elderly driving population referred to a geriatric assessment center.

A retrospective, case-control study was performed to determine the characteristics of elderly drivers referred to an outpatient geriatric assessment center. It was hypothesized that the driving population was operating at a higher cognitive and functional level than nondrivers. One hundred eighty-two subjects meeting the entry criteria were studied. Twenty-three percent of the subjects were driving at the time of their assessment. Compared to nondrivers, drivers were younger (P = .0001), were more likely to be male (P = .003), scored higher on a mental status examination (P = .0001), and were more independent in Physical and Instrumental Activities of Daily Living (P less than .0001). Despite these findings, the mean Folstein Mini-Mental score for drivers (23.7) was below normal; 40% of drivers were diagnosed as having Alzheimer's dementia at the time of their evaluation, and over 26% of the drivers needed help with either dressing or bathing. The frequency of impaired elderly drivers in this referral setting was high. The authors conclude that conditions that affect the driving task are common in geriatric assessment centers. Prospective studies of elderly drivers are needed to answer the difficult question of who among the elderly should drive.

Activities of Daily Living↗
PubMed1990

Infant feeding practices: an evaluation of the impact of a health education course.

We assessed the impact of a health education course on infant feeding practices in the West Bank territories by comparing mothers who had attended the course (n = 102) with mothers not exposed to the course (n = 133). After adjustment for child's age, maternal age and education, parity, and birth site, course participants were more likely than non-participants to breastfeed, as well as to start supplementation by semi-solid foods at the recommended time.

Breast Feeding↗
PubMed1990

Effect of single setting versus multiple setting training on learning to shop in a department store.

The effects of single versus multiple setting training on the generalization of shopping skills to untrained department stores were analyzed. One group received training in a single department store and the other, in three different stores. Measures were taken on operational behaviors, social behaviors, number of settings in which criterion performance was achieved, and number of sessions required to achieve criterion within the training settings. No differences between groups were found as a result of training condition. We concluded that for some individuals with mental retardation, training in either single or multiple settings may be sufficient for generalization.

Adolescent↗
PubMed1988

Fine adjustment of thyroxine replacement dosage: comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment.

Thyroxine replacement therapy for 21 adult patients with primary hypothyroidism was adjusted to the dosage at which each patient had a normal thyrotrophin (TSH) response to thyrotrophin releasing hormone (TRH). Clinical assessment and measurement of TSH (by sensitive immunoradiometric assay), free thyroxine (FT4) and free tri-iodothyronine (FT3) were made at this dosage and at higher and lower doses of thyroxine. Clinical observations, FT3 and FT4 assays were relatively insensitive to small alterations of thyroxine dosage, in contrast to which basal TSH measurements correlated well with TRH responsiveness and were sensitive to fine adjustments of thyroxine dosage.

Adult↗
PubMed1987

Antibody-guided irradiation of hepatic metastases using intrahepatically administered radiolabelled anti-CEA antibodies with simultaneous and reversible hepatic blood flow stasis using biodegradable starch microspheres.

Two monoclonal antibodies to carcinoembryonic antigen (CEA) were radiolabelled with 131I and used for the treatment of hepatic metastases in a patient who had a primary colonic carcinoma. Approximately 100 mCi of 131I-labelled antibody were administered via the hepatic artery on two occasions. On the second occasion, radiolabelled antibody was given concurrently with biodegradable starch microspheres in an attempt to enhance tumour uptake of antibody by achieving temporary stasis or delay of hepatic blood flow. The procedure was carried out uneventfully. There was clinical improvement and a fall in circulating CEA levels after each course of treatment. Furthermore, after the second course of therapy the clinical improvement was sustained for a longer period (more than 3 months) and there was evidence of diminution in the size of some of the liver metastases. Regional administration of 131I-labelled anti-CEA antibody concurrently with biodegradable starch microspheres appears to be a promising new method for the treatment of hepatic metastases from colonic carcinoma.

Adenocarcinoma↗
PubMed1987

IgG subclass distribution of thyroid autoantibodies: a 'fingerprint' of an individual's response to thyroglobulin and thyroid microsomal antigen.

The IgG subclass distribution of autoantibodies to thyroglobulin and thyroid microsomal antigen was studied in 21 patients with Graves' disease during fluctuations in total IgG class autoantibody levels induced by various forms of therapy. In addition, changes in autoantibody subclass distributions were investigated during the natural course of Hashimoto's disease in seven patients taking thyroxine. The autoantibodies were principally of subclasses IgG1 and/or IgG4 in Graves' patients although IgG2 contributed significantly to thyroglobulin antibodies in 5/7 Hashimoto sera. In Graves' disease the distribution of microsomal and thyroglobulin antibodies among the IgG subclasses remained essentially unchanged over periods of 6 months-2 years whether autoantibody levels decreased during carbimazole therapy or increased transiently following 131Iodine treatment or subtotal thyroidectomy. Similar observations were made for thyroglobulin antibodies in Hashimoto patients studied over 2 1/2-4 years; furthermore, the IgG subclass distribution of microsomal antibodies was usually different from that of thyroglobulin antibodies in the same patient. These observations suggest that the microsomal and/or thyroglobulin antibody subclass distribution is characteristic for a particular individual and may be regarded as the 'fingerprint' of an individual's response to these thyroid autoantigens.

Adolescent↗
PubMed1987

Sheehan's syndrome presenting with type III hyperlipoproteinaemia.

A patient is described in whom the presenting feature of hypopituitarism was the development of palmar xanthomata associated with type III hyperlipoproteinaemia. Treatment of her secondary hypothyroidism with thyroxine caused resolution of the xanthomata and hyperlipidaemia, but the underlying compositional abnormality of the lipoproteins could still be observed.

Adult↗
PubMed1987

Economy and efficiency in routine thyroid-function testing: use of a sensitive immunoradiometric assay for thyrotropin in a general hospital laboratory.

We measured thyrotropin (TSH) with a sensitive immunoradiometric assay (IRMA) in 2329 consecutive serum samples received for thyroid-function tests from hospital and general practice. Of these, 185 (7.9%) had TSH values less than 0.2 milli-int. unit/L: 33 (1.4%) were hyperthyroid, 20 (0.9%) were being treated for hyperthyroidism, 115 (4.9%) were receiving L-thyroxin, and 17 (0.7%) were clinically euthyroid but had severe non-thyroidal illnesses. In the first 506 serum samples, we also measured free thyroxin, free triiodothyronine (FT3), and total thyroxin. Thyroliberin (thyrotropin-releasing hormone, TRH) tests performed on 84 patients showed that an undetectable initial TSH (usually ascribable to therapy with thyroxin) predicted a flat TRH response. All untreated thyrotoxic patients had undetectable TSH. Experience confirmed that this TSH assay, in conjunction with a supplementary assay of FT3 when the TSH concentration is less than twice the limit of detection, is efficient and economical for routine evaluation of thyroid function in an unselected population.

Adult↗
PubMed1987

Investigation of anterior pituitary function in elderly in-patients over the age of 75.

Dynamic pituitary function tests were carried out on 50 randomly selected in-patients, (30 women and 20 men) over the age of 75 during early convalescence. Twenty-five subjects also had CT scans of the pituitary fossa. One male patient had hypogonadotrophic hypogonadism; another had a large prolactinoma and hypothyroidism; these were excluded from the analysis. Of the remaining 48 subjects, 14 (29 per cent) had reduced TSH responses to TRH and 28 (64 per cent) decreased GH responses to L-dopa compared with our laboratory's reference ranges. Fifteen women (51 per cent) had low basal gonadotrophin levels of which 10 (34 per cent) gave a poor LH response to LHRH and eight (27 per cent) a poor FSH response. Forty-three subjects (93 per cent) gave a good ACTH response to metyrapone. Only six subjects (24 per cent) had an apparently normal pituitary fossa; 16 (64 per cent) had partially or completely empty fossas. There was no significant correlation between the diminished pituitary responses. Only one patient had responses which suggested panhypopituitarism. There was also no significant correlation between the appearance on CT scan of the pituitary fossa and the results of the dynamic tests. It is suggested that laboratory reference range for pituitary function which have been derived from young ambulatory subjects are not appropriate for hospital in-patients over the age of 75. A series of reference ranges for such subjects is proposed.

Aged↗
PubMed1986

Liver lobe disparity consequent upon atrophy. Diagnostic, operative and therapeutic considerations.

Liver lobe disparity consequent upon lobar atrophy with compensatory hypertrophy of the contralateral lobe is a pathological entity usually encountered with high bile duct obstruction and is associated with particular diagnostic and operative problems, discussed here by reference to 10 patients. The hypertrophied lobe presented as an abdominal 'mass' in all 10 whilst the atrophied lobe imitated a 'cold' area on liver scintigraphy and was misinterpreted as a tumour in 2 cases. The operative difficulties, exemplified by 8 patients, arise from the distortion of the configuration of the liver, the alteration of the anatomical relations of the vascular and biliary structures, and the reduced functional capacity of the atrophied liver. Pre-operative diagnosis of the condition is important to allow optimal treatment.

Adult↗
PubMed1986

Preoperative localization of parathyroid adenomas using thallium-technetium subtraction scintigraphy.

Primary hyperparathyroidism can be diagnosed by laboratory values, yet localization of the adenomas preoperatively has always presented difficulties. Dual isotope scintigraphy with technetium Tc 99m sodium pertechnetate and thallium Tl-201 chloride has recently been used for the localization of parathyroid adenomas. In this paper, we review our experience with scintigraphy in 53 patients suspected of having hyperparathyroidism. Based on favorable results, we recommend this technique for preoperative detection of parathyroid adenomas.

Adenoma↗
PubMed1986

Expectant management of patients with unilateral hepatic duct stricture and liver atrophy.

Three patients with postcholecystectomy unilateral hepatic duct stricture and subsequent liver atrophy were treated conservatively, with a successful outcome of up to three years follow up. A better understanding of the pathophysiological sequelae of segmental hepatic duct obstruction suggests that in such circumstances reconstructive surgery, with its attendant risks, may not invariably be necessary.

Adult↗
PubMed1986

Antibody-guided radiolocalisation of tumours in patients with testicular or ovarian cancer using two radioiodinated monoclonal antibodies to placental alkaline phosphatase.

Monoclonal antibodies (H317 and H17E2) against placental-type alkaline phosphatase and testicular placental-like alkaline phosphatase were radiolabelled with 123I or 131I and used in a prospective study of patients with germ-cell neoplasms of the testis (13 studies) or epithelial-origin neoplasms of the ovary (13 studies). The presence of tumour was confirmed in the majority of patients with active disease by antibody scanning. The absence of tumour was confirmed in all cases in patients in complete remission. In two patients with positive antibody scans but no disease found by conventional radiological evaluation, further investigations subsequently revealed the presence of tumour. A positive antibody scan indicates the definite presence of a tumour, although a negative antibody scan does not always exclude the presence of disease. This method may be of clinical value in establishing disease status in patients with potentially curable diseases such as ovarian or testicular cancers.

Adult↗
PubMed1985

Pulmonary haemorrhage complicating Wegener's granulomatosis and microscopic polyarteritis.

The incidence and characteristics of pulmonary haemorrhage in a series of 89 patients with systemic vasculitis were analysed. Pulmonary haemorrhage occurred in 32 of these patients and was associated with haemoptysis in all 32, alveolar shadowing in the chest radiograph in 28, and a significantly raised transfer coefficient in 30. Pulmonary haemorrhage usually resolved with treatment by immunosuppressive drugs but was the cause of death in 11 patients. In contrast with patients with antibasement membrane antibodies there was no correlation between pulmonary haemorrhage and cigarette smoking. Pulmonary haemorrhage is a cause of serious morbidity in patients with systemic vasculitis.

Arteritis↗