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Biomedical subjects

D Ellis

Publications and source records attributed to D Ellis.

At least 73 records · Page 4Linked to original sources
PubMed1995

Evaluation and management of bilateral renal artery stenosis in children: a case series and review.

This report describes the clinical course, diagnostic evaluation and management of six children with bilateral renal artery stenosis (RAS) and concurrent narrowing of the abdominal aorta. Except for one child with active arteritis, the others were asymptomatic. There were no clinical or laboratory features suggesting the etiology of hypertension in four of six patients, and diagnostic procedures, including Doppler duplex ultrasound and captopril scintigraphy, were unreliable in screening for such hypertension. Abdominal aortography and selective renal angiography confirmed the diagnosis of bilateral RAS and associated anatomical alterations of the aorta and its branches. The hypertension was severe and minimally responsive to antihypertensive agents. It was cured or improved after percutaneous transluminal angioplasty (PTA) of three vessels in two children with mid-vessel stenoses, while hypertension persisted after PTA of two mid-vessel stenoses in a third child and one vessel with ostium stenosis in a fourth child. Autotransplantation of seven kidneys in four children resulted in cure of significant improvement of the hypertension. Renal function was preserved in all children during a mean follow-up time of 41 months. Based on illustrative data from these six children, as well as information from a review of the literature, this report discusses the key diagnostic issues and stresses the potential advantages of renal autotransplantation in selected children with this disorder.

Adolescent↗
PubMed1995

Intracellular pH during hypoxia in normal and hypertrophied right ventricle of ferret heart.

The effects of preventing oxidative phosphorylation on pHi were compared in papillary muscles from right ventricles of normal and pressure-overloaded ferret hearts. Hypertrophy was induced by pulmonary artery clipping for 30-45 days. pHi was recorded with pH-sensitive microelectrodes. Resting pHi and the relationship between intracellular buffering power and pHi were not modified by the hypertrophy. At 22 degrees C, the initial intracellular alkalosis following exposure to oxygen-free Tyrode solution (containing the reducing agent sodium dithionite, 1 mM), as well as the transient acidosis on return to oxygenated solution, were reduced in hypertrophied papillary muscles. During hypoxia, exposure to alpha-cyano-4-hydroxycinnamate (5 mM) induced a larger intracellular acidification in hypertrophied than in control muscle. The initial alkalosis during hypoxia and the extra acidification on recovery from hypoxia were also significantly reduced in hypertrophied muscles at 35 degrees C. Moreover, the acidification during hypoxia was markedly accentuated in hypertrophied preparations at this temperature. [Mg2+]i and [Ca2+]i were also measured during metabolic inhibition, using mag-fura-2 and fura-2 respectively, in isolated cells from control and hypertrophied right ventricles. Hypertrophy increased the resting level of [Ca2+]i and of [Mg2+]i by a factor of 2.5 (P < 0.001) and 1.3 (P < 0.05) respectively. Upon application of 15 mM 2-deoxyglucose, [Mg2+]i was increased to a similar extent in control and hypertrophied cells. It is concluded that right ventricular hypertrophy could modify creatine phosphate metabolism and the capacity to recruit anaerobic glycolysis.

Animals↗
PubMed1995

Personality disorder and sexual risk taking among homosexually active and heterosexually active men attending a genito-urinary medicine clinic.

61 homosexually active men and 57 heterosexually active men attending a genito-urinary medicine clinic were assessed for personality disorder and sexual risk taking. Of the homosexually active men, 23/61 (38%) were found to have personality disorders, as against 16/57 (28%) of the heterosexually active men. Multiple regression analysis indicated that antisocial personality disorder (p < 0.001) was the main predictor of sexual risk taking for the homosexually active clinic attenders. In the case of the heterosexually active men attending the clinic, sexual risk taking was predicted by cocaine use (p < 0.001) and antisocial personality disorder (p < 0.001). These results indicate a need to screen for personality disorders in genitourinary medicine clinics and at the time of pre-HIV test counseling.

Adolescent↗
PubMed1995

High mortality from unidentified CVD in IDDM: time to start screening?

Mortality in insulin-dependent diabetes is markedly increased compared to the general population. Although strong associations have been found between renal disease and the risk of cardiovascular disease (CVD) the interaction between these two factors is not well understood. This study, which addresses risk factors for mortality in IDDM with a particular focus on the renal-CVD link, is based on the prospective Epidemiology of Diabetes Complications study. Thirty-seven (mean age 36 years, mean duration of IDDM 28 years at baseline) of the 658 IDDM individuals (mean age 28 years, mean duration of IDDM 20 years at baseline) have died in the first 4 years of follow up. A nested case-control study was performed, matching on sex and duration of diabetes. Twenty-two (59%) of the deaths were attributed to coronary heart disease, with an additional 16% attributed to diabetic coma. Only nine (41%) of the 22 individuals who died from cardiovascular disease had clinical evidence of coronary heart disease when seen for their last biennial exam. However, 54% of those who died of CVD without prior evidence did have evidence of lower extremity arterial disease. A strong link with renal disease was confirmed, with 81% of those with a coronary artery disease death having renal disease. Multivariate analyses suggest that smoking history, triglycerides and total platelet count are independent predictors of mortality, while LDL cholesterol best predicted CVD mortality. These results suggest a need for more intensive screening for cardiovascular disease, and correction of cardiovascular risk factors, in order to reduce the increased rate of mortality in this population. Efforts to prevent or delay the onset of renal disease may also be of benefit.

Adult↗
PubMed1995

Terbinafine in onychomycosis of the toenail: a novel treatment protocol.

BACKGROUND: Current treatment of onychomycosis of the toenail is poor and relapse is common. OBJECTIVE: Our purpose was to assess the efficacy and safety of oral terbinafine and placebo in onychomycosis of the toenail with the use of a novel treatment protocol. METHODS: This was a randomized, double-blind, 48-week study. Twelve weeks of terbinafine (250 mg daily) or placebo was followed by 12 weeks of observation. Responders received no further treatment and nonresponders were offered 12 weeks of terbinafine (250 mg daily) from week 28. RESULTS: Of 111 evaluable patients, 88% (49 of 56) of the patients given terbinafine and 29% (16 of 55) of the patients given placebo had a negative mycologic culture at week 24 (p < 0.001), 57% (32 of 56) of the terbinafine group and 6% (3 of 55) of the placebo group were responders (p < 0.001). By week 48, after the terbinafine nonresponders were given a second 12-week course of terbinafine, the overall mycologic cure rate for the patients given terbinafine was 94%. CONCLUSION: High mycologic cure rates in onychomycosis of the toenail can be achieved by terbinafine by this novel treatment regimen.

Adolescent↗
PubMed1995

Information in primary health care.

The results of two recently completed studies, one in the Trent Region and the other in the Anglia and Oxford Region, of the information-related behaviour of general medical practitioners (GPs) and of information activities within the general practices illustrating the information seeking behaviour of GPs, their generation of information, and communication within, to and from the practice. GPs stated that there is a need for more information to enable practices to function within the changing NHS environment. The increasing emphasis on evidence-based medicine also creates the need for appropriate information sources. The Trent study resulted in guidelines for best information practice, especially the need for each practice to have an information strategy. The Anglia and Oxford Study examined the role which the library and information services could play in supporting primary health care.

Communication↗
PubMed1995

A case of Pelizaeus-Merzbacher disease showing increased dosage of the proteolipid protein gene.

Clinical, neuropathological and molecular genetic studies in a 9 month old boy with Pelizaeus-Merzbacher disease are described. The principal clinical features were developmental delay, nystagmus, stridor and seizures. Both brain and spinal cord showed almost complete absence of stainable central myelin, while cranial and spinal root myelin was preserved. Probes for cDNA in the boy and his asymptomatic mother indicated an increase in the dosage of proteolipid protein gene (of at least twofold) compared with controls.

DNA Probes↗
PubMed1995

Atypical hyperlipidemia and nephropathy associated with apolipoprotein E homozygosity.

Hyperlipidemia has been implicated in the pathogenesis of experimental progressive glomerulosclerosis, but its role in human renal injury is controversial. This report describes a 12-yr-old boy presenting with massive proteinuria, hepatomegaly, anemia, severe mixed hyperlipidemia, and progressive renal failure. The initial renal biopsy disclosed large numbers of foam cells that were shown to be monocytes. Evidence is presented suggesting that apoprotein-E2 homozygosity in our patient, together with an 88% reduction in plasma lipoprotein lipase activity associated with severe nephrotic syndrome, is responsible for the atypical clinical features, lipoprotein phenotype III with chylomicronemia, and renal lipidosis. A regimen of dietary lipid restriction, gemfibrozil, and niacin resulted in significant but partial improvement of the dyslipidemia and resolution of the hepatomegaly and ascites. This report stresses the importance of characterizing unique lipid disorders in patients with nephrotic syndrome in order to prescribe effective lipid-lowering strategies. Moreover, the striking resemblance of the clinical and nephrohistologic features of this patient to those occurring in experimental models of coexisting glomerular injury and hyperlipidemia led to the speculation that, in this setting, the hyperlipidemia may contribute to the development of progressive glomerulosclerosis.

Apolipoproteins E↗
PubMed1995

The influence of pregnancy on IDDM complications.

OBJECTIVE: Although pregnancy has been associated with an increased progression of certain insulin-dependent diabetes mellitus (IDDM) complications, particularly retinopathy, both the short- and long-term relationships between pregnancy and both neuropathy and macrovascular disease are poorly documented. This study was conducted to comprehensively examine the influence of pregnancy on the development and progression of IDDM complications. RESEARCH DESIGN AND METHODS: Using the Pittsburgh Epidemiology of Diabetes Complications Study population (childhood-onset IDDM), two nested, pair-matched case-control studies were conducted. Women who had completed at least one successful pregnancy (n = 80) were matched to women with no history of pregnancy by age, duration of IDDM, race, and marital history. The first nested study (study 1) compared the prevalences of five IDDM complications between case and control groups. The second nested study (study 2) compared the incidences of the same five complications over an approximate 2-year interval during which the case subjects (n = 30) completed a successful pregnancy. RESULTS: There were no significant differences in the prevalence rates of coronary heart disease, neuropathy, proliferative retinopathy, lower extremity arterial disease, and overt nephropathy by case-control status, while parity did not predict any complication in multiple logistic analysis (study 1). In study 2, there were small but nonsignificant differences in incidence rates of overt nephropathy and lower extremity arterial disease between the groups, whereas case subjects had almost 3 times the incidence rate of proliferative retinopathy (P = 0.58) and 10 times the incidence rate of neuropathy (P < 0.001) as did other matched control subjects. In multivariate analysis, parity predicted neuropathy incidence but did not predict the incidence of any other complication, including proliferative retinopathy. CONCLUSIONS: Women with IDDM who experience a pregnancy may not be at an increased risk of diabetes complications later in life. However, in the short term, pregnancy may accelerate the development of some complications, such as neuropathy.

Adult↗
PubMed1995

A balance of tastes. Chefs & dietitians roundtable discussion.

The demands from foodservice customers for healthier foods that also taste good have compelled chefs & dietitians to break off their traditional separation of powers & begin forming working partnerships. These new partnerships are producing menus that strike a balance just as new--a balance between the preferences & priorities of both professions. It means a combining of two different but not incompatible perspectives that magnifies both the pleasure & the benefit of the good food they serve. In recognition of these new partnerships, FM convened the first roundtable with chefs & dietitians, all of whom are on the leading edge of this emerging trend. Excerpts of their discussion reflect striking similarities in opinion--as well as differences still to be reconciled.

Diet, Vegetarian↗
PubMed1995

Information in general medical practice: a qualitative approach.

The aims of the study reported here were to describe the information-related behavior of general medical practitioners, to study information communication in general practices, and to establish guidelines for good practice. General practitioners (GPs) were interviewed, and information and communication audits also involving other staff at the practices were undertaken. The main reasons why GPs needed information were for patient care, managing the practice, legal and ethical matters, and teaching trainee GPs. Most practices had problems with internal and external communication and the storage and retrieval of information. The main conclusion is that practices need to have an information strategy that considers human, manual, and computer aspects of information handling.

Appointments and Schedules↗
PubMed1995

Benefits realised from a blood transfusion policy for elective joint arthroplasty.

Transfusion practice and blood ordering policy for major joint replacement was studied during 1989-93. Existing practice requiring automatic preoperative cross-match was prospectively audited. A blood ordering policy rationalising transfusion practice, using the group and screen technique, was then introduced. This resulted in a decrease in the total number of units cross-matched and increased the transfusion fraction significantly. The percentage of blood returned to the blood bank decreased by 46% for knees and 41% for hip arthroplasty. After the introduction of low molecular weight heparin (LMWH) as routine deep vein thrombosis (DVT) prophylaxis for all major total joint arthroplasties, the total transfusion requirement did not increase. In fact, the average number of units transfused per case after its introduction was marginally less at 1.3 units per hip, and 0.9 units per knee.

Arthroplasty↗
PubMed1995

The superiority of tacrolimus in renal transplant recipients -- the Pittsburgh experience.

Tacrolimus is a superior immunosuppressive agent in patients undergoing renal transplantation. In adults, the 1- and 3-year actuarial patient survivals were 95% and 92%, and the 1- and 3-year actuarial graft survivals were 89% and 80%. For first cadaver kidneys, the 1- and 3-year actuarial graft survivals were 91% and 82%, with a projected half-life of 11.9 years. Sixty-nine percent of successfully transplanted patients were weaned off steroids. In pediatric patients, the 1- and 4-year actuarial patient survivals were 100% and 96%, and the 1- and 4-year actuarial graft survivals were 99% and 85%. Seventy-three percent of successfully transplanted children were weaned off steroids. Tacrolimus was also useful as a rescue agent, with an initial success rate of 74%. Tacrolimus has been used successfully in kidney/ pancreas transplantation, with 100% patient, 95% kidney, and 79% pancreas graft survival. Tacrolimus should be considered the immunosuppressive agent of choice in renal transplantation.

Adolescent↗
PubMed1995

Measurement of intracellular ionized magnesium concentration in myocytes isolated from the septomarginal band of sheep hearts.

The preparation by collagenase dispersion is described of isolated, calcium-tolerant myocytes from the septomarginal (moderator) band dissected from the sheep heart. Cells obtained were small rods (85 x 9 microns), with pronounced striations characteristic of cardiac myocytes. Isolated cells were loaded with the fluorescent ion-sensitive probes Mag-fura-2 or fura-2, for use in microspectrofluorimetry experiments to measure cytosolic free magnesium ([Mg2+]i) and calcium ([Ca2+]i) respectively; cells remained usable for up to 8 h after isolation. Glycolysis and electron transport were inhibited by a short exposure (4 min) to deoxyglucose (15 mM) and cyanide (2 mM), added simultaneously. This appeared to produce a small, but not statistically significant (P = 0.056) rise in [Mg2+]i, presumably resulting from Mg2+ liberated following consumption of MgATP. Inhibition of the Na pump by strophanthidin (20 microM), followed by removal of external Na in the presence of strophanthidin, caused an increase in both [Mg2+]i and [Ca2+]i. The time course of changes in the two ions were dissimilar, so it seems unlikely that the observed rise in the [Mg2+]i was due solely to a direct effect of [Ca2+]i on Mag-fura-2 or due to the displacement of [Mg2+]i by Ca from binding sites. Evidence is presented that suggests sodium-magnesium exchange plays a role in the regulation of myocyte [Mg2+]i.

Animals↗
PubMed1994

Hypoxia-induced intracellular acidification in isolated sheep heart Purkinje fibres and the effects of temperature.

The changes of intracellular pH (pHi) produced by hypoxia in sheep heart Purkinje fibres were studied using liquid ion exchanger-filled microelectrodes. A decrease of temperature from 35 degrees C to 22 degrees C caused an alkalinization of 0.3 pH units. Hypoxia (partial pressure of oxygen < 10 mm Hg) for 20 min induced an acidification of 0.26 +/- 0.18 units (n = 14) at 35 degrees C. The hypoxia-induced acidification at 22 degrees C was smaller than that at 35 degrees C by approximately 65%. Increasing the buffering capacity of the cells decreased the hypoxic acidification. This could be achieved either by use of high extracellular HEPES concentrations (40 mM) or by the use of bicarbonate buffers. Sodium cinnamate (5 mM) increased the hypoxic acidification and slowed the pHi recovery on reintroduction of oxygen, implying an importance role for lactate flux in pH regulation during hypoxia.

Animals↗
PubMed1994

Comparison of FK-506 and cyclosporine regimens in pediatric renal transplantation.

Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n = 13) or a mean dosage of 0.07 mg/kg per day (n = 4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient, P < 0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in pre-adolescents receiving FK-506 but no prednisone (P < 0.02 and P < 0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone.

Adolescent↗