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Biomedical subjects

D J Moore

Publications and source records attributed to D J Moore.

At least 163 records · Page 9Linked to original sources
PubMed1986

"Conversion reactions" in adolescents: a biofeedback-based operant approach.

This paper describes the brief in-patient treatment of two adolescents with hysterical conversion disorder. It is unique in that treatment was conducted on a general medical/surgical service. Although operantly based, the treatment utilized biofeedback and measurable psychophysiological changes as criteria to obtain reinforcement. The advantages of this approach to both patient and hospital staff are discussed.

Adolescent↗
PubMed1986

Testing times?

Explore the source record for details and available documents.

Education, Nursing↗
PubMed1986

Abnormalities of circulating immunoreactive pancreatic anionic trypsinogen in cystic fibrosis: an assay artifact due to cross-reacting serum antibodies.

In patients with CF, serum pancreatic cationic trypsinogen has proven to be useful for newborn diagnostic screening and also as a test of pancreatic function in the older patient. However, an assay for serum anionic trypsinogen is of no value as a test of pancreatic function in CF due to an apparent artifactual elevation of this enzyme in some patients. In this study, we evaluated the extent of the abnormality in the anionic trypsinogen assay and also elucidated the nature of the interfering material. CF patients were grouped according to the presence (pancreatic insufficiency) or absence (pancreatic sufficiency) of steatorrhea. In CF infants, both serum cationic and anionic trypsinogen levels were greatly elevated. Serum cationic trypsinogen declined with age in patients with pancreatic insufficiency, reaching low or undetectable levels after 6 years. In contrast, serum anionic trypsinogen levels remained normal or elevated in 33% of those over 6 years of age. There was no age-related change in either cationic or anionic trypsinogen among the CF patients with pancreatic sufficiency, and the majority had normal or elevated levels. Serum samples from selected CF patients were separated into IgG and non-IgG fractions using Staph. Protein A columns. Immunoreactive cationic and anionic trypsinogen were detectable in the non-IgG fractions of sera from CF infants and older patients with pancreatic sufficiency. In older CF patients with undetectable serum cationic and anionic trypsinogen, no immunoreactive material was detectable in either the IgG or non-IgG fractions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

The influence of duplex scanning on early patency rates of in situ bypass to the tibial vessels.

Duplex scanning was used in the follow up of 49 in situ infrapopliteal bypasses per formed for limb salvage using the valve incision method. In 19 cases (39%) the peroneal artery was the best available vessel for distal insertion; the anterior tibial and dorsalis pedis were used in 17 cases (35%) and the posterior tibial artery and tibioperoneal trunk in 13 cases (26%). In the early postoperative period three AV fistulas presented with painful skin lesions. These were located using duplex scanning and following ligation rapid resolution followed. Primary patency at one month was 87% and was increased to 96% by successful correction of four out of six failed bypasses. A total of 11 stenoses were found in five bypasses between three and 15 months postoperatively. In four of these patients the ankle/arm index decreased by at least 0.15 between examinations. A comparison was made between the spectral analysis on duplex scanning and the findings on arteriography and at operation. Peak systolic frequencies greater than 6,000 Hz were associated with 50% or greater reduction in vein bypass diameter. The majority were corrected using vein patch angioplasty. Primary cumulative patency at two years was maintained at 68% while correction of two out of seven bypass failures raised this to 80%. Duplex scanning allows precise definition of vein bypass pathology, facilitates operative correction and increases long-term limb salvage.

Aged↗
PubMed1986

Distribution of venous valvular incompetence in patients with the postphlebitic syndrome.

The records of 122 patients who underwent Doppler evaluation for the postphlebitic syndrome were reviewed to determine the relationship between location of venous valvular incompetence and severity of clinical signs. Categorized according to the most severe physical finding, there were 35 limbs with perimalleolar ulcers, 113 with stasis pigmentation, 26 with swelling, and 70 with no overt signs. Incompetent veins, either deep or superficial, were present in 93% of the symptomatic and 59% of the asymptomatic limbs. Proximal (iliofemoral) deep venous incompetence was not strongly correlated with disease severity (p less than 0.10), but distal (popliteotibial) deep venous and superficial venous incompetence were (both, p less than 0.0005). The relative frequency of isolated proximal incompetence appeared to diminish with increasing disease severity; whereas that of distal incompetence, with or without associated proximal venous incompetence, increased. Isolated proximal venous incompetence was found in only 5% of limbs with severe disease (ulcers or pigmentation). In limbs with severe signs, distal venous incompetence was present in 67% of those with proximal venous incompetence and in 57% of those in which the proximal valves were competent. These findings cast doubt on the potential value of proximal venous valvular reconstruction, especially in limbs with combined proximal and distal insufficiency.

Adolescent↗
PubMed1986

Relative accuracy of the diagnostic components of noninvasive carotid arterial tests: a comparison of pulsed Doppler arteriography and spectrum analysis.

Pulsed Doppler ultrasonography (UA), sound spectrum analysis, and subjective interpretation of the audible signal are valuable methods for assessing carotid arterial disease; however, the relative contribution of each in making a diagnosis is disputed. To investigate this issue, 258 noninvasive carotid studies with measured x-ray comparisons were reviewed. Internal carotid spectra, UA images, and images combined with the technician's comments were each interpreted blindly by three independent readers. Percentage of stenosis was categorized into six groups: 0, 1% to 24%, 25% to 49%, 50% to 74%, 75% to 99%, and 100%. Each reader's assessment of the individual noninvasive components and his overall reading of the complete study were compared with x-ray findings and with those of the other two readers. The readings of the three observers were consistent within each diagnostic component (p less than 0.001). For each reader, the technician's comments significantly improved the accuracy of ultrasonic imaging alone (p less than 0.001). Spectrum analysis was as good as the image plus technician's comments and, for two of three readers, was better than the image alone (p less than 0.001).

Angiography↗
PubMed1986

Physiology of the peaked finger pulse in normal and cold-sensitive subjects.

A unique peaked digital pulse contour (DPC) is frequently observed in patients with cold sensitivity, but the pathophysiology of this pulse remains obscure. To investigate the responses of the DPC to cold exposure, finger blood pressure (FBP), finger blood flow (FBF), and finger skin temperature (FST) were measured in fingers of both hands of 13 normal subjects and in 16 patients with cold sensitivity. The ratio, FBP/FBF, was used to estimate small vessel resistance (SVR). One hand was immersed sequentially in water at 40 degrees, 30 degrees, 20 degrees, and 10 degrees C, while the other hand remained in room air. DPCs were classified as normal (N), intermediate (I), intermediate-peaked (IP), peaked (P), obstructive (O), and spastic obstructive (SO). At room temperature, fingers with I, IP, O, and SO pulses had increased SVRs and decreased FSTs, and those with O and SO had decreased FBP. On cold exposure IP pulses appeared in both hands of both normal and cold-sensitive subjects, but P pulses developed only on the cooled side. IP and P pulses were associated with an increase in SVR. We concluded that IP pulses are related to reflex sympathetic arteriolar vasoconstriction, that P pulses imply vasoconstriction produced directly by cold exposure, and that O, SO, or absent pulses are indicative of digital arterial vasospasm.

Adolescent↗
PubMed1986

Serum immunoreactive cationic trypsinogen: a useful indicator of severe exocrine dysfunction in the paediatric patient without cystic fibrosis.

We evaluated serum cationic trypsinogen as a marker of exocrine pancreatic function in children without cystic fibrosis. The ability of this test to determine steatorrhoea of pancreatic origin, and its relationship to a wide range of exocrine pancreatic function were assessed. Serum trypsinogen was measured in 32 children with steatorrhoea, 10 with pancreatic and 22 with non-pancreatic causes. In patients with pancreatic steatorrhoea, serum cationic trypsinogen was 4.9 +/- 4.9 micrograms/l (mean +/- SD), significantly below values in patients with non-pancreatic steatorrhoea (47.0 +/- 22.1 micrograms/l, p less than 0.001) and 50 control subjects (31.4 +/- 7.4 micrograms/l, p less than 0.001). Serum cationic trypsinogen values in patients with pancreatic steatorrhoea all fell below the lower limit of our control range and below all values for patients with non-pancreatic steatorrhoea. Serum cationic trypsinogen was also evaluated against pancreatic trypsin output in 47 patients (range 0.2-17.0 yr who underwent a hormonal pancreatic stimulation test. In 17 patients, serum cationic trypsinogen was low (less than -2SD or less than 16.6 micrograms/l), and associated with greatly impaired pancreatic trypsin output, ranging from 0-8% of mean normal trypsin output. Five of these 17 patients did not have steatorrhoea. In 30 patients with normal or raised serum cationic trypsinogen (greater than or equal to 16.6 micrograms/l), pancreatic trypsin output ranged from 15-183% of mean normal values. In conclusion, low serum cationic trypsinogen suggests severely impaired exocrine pancreatic function, with sensitivity extending above the steatorrhoeic threshold. In the presence of steatorrhoea, low serum cationic trypsinogen indicates a pancreatic aetiology. Normal serum cationic trypsinogen, however, does not exclude impaired pancreatic function, above the steatorrhoeic threshold.

Adolescent↗
PubMed1986

Age-related alterations of immunoreactive pancreatic cationic trypsinogen in sera from cystic fibrosis patients with and without pancreatic insufficiency.

Serum immunoreactive cationic trypsinogen levels were determined in 99 control subjects and 381 cystic fibrosis (CF) patients. To evaluate the status of the exocrine pancreas all CF patients had previously undergone fecal fat balance studies and/or pancreatic stimulation tests. Three hundred fourteen CF patients had fat malabsorption and/or had inadequate pancreatic enzyme secretion (pancreatic insufficiency) requiring oral pancreatic enzyme supplements with meals. Sixty-seven CF patients did not have fat malabsorption and/or had adequate enzyme secretion (pancreatic sufficiency) and were not receiving pancreatic enzyme supplements with meals. Mean serum trypsinogen in 99 control subjects was 31.4 +/- 14.8 micrograms/liter (+/- 2 SD) and levels did not vary with age or sex. In CF infants (less than 2 yr) with pancreatic insufficiency, mean serum trypsinogen was significantly above the non-CF values (p less than 0.001). Ninety-one percent of the CF infants had elevated levels. Serum trypsinogen values in the pancreatic insufficient group declined steeply up to 5 years, reaching subnormal values by age 6. An equation was developed which described these age-related changes very accurately. Only six CF patients with pancreatic insufficiency had serum trypsinogen levels above the 95% confidence limits of this equation. In contrast, there was no age related decline in serum trypsinogen among the CF group with pancreatic sufficiency. Under 7 yr, serum trypsinogen failed to distinguish the two groups. In those over 7 yr of age, however, serum trypsinogen was significantly higher than the CF group with pancreatic insufficiency (p less than 0.001), and 93% had values within or above the control range.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

High-performance liquid chromatographic assay for the antitumor glycoside phyllanthoside and its stability in plasma of several species.

Phyllanthoside is a glycoside isolated from the roots of the Central American tree Phyllanthus acuminatus Vahl with antitumor activity against murine B-16 melanoma and P-388 leukemia. We report a reversed-phase high-performance liquid chromatographic assay for phyllanthoside in plasma using a 25-cm RP-18, 5-micron column with a linear 10-min gradient of 50% to 100% methanol in 0.3 M sodium acetate, pH 4.0, at a flow-rate of 1.5 ml/min. Eluting peaks were detected at 270 nm. The lower limit of sensitivity of the assay for phyllanthoside in 0.5 ml plasma following ethyl acetate extraction at pH 7.0 was 0.25 micrograms/ml and the coefficient of variation at 1 microgram/ml was +/- 7.4%. Phyllanthoside was very rapidly broken down by mouse and rat plasma in vitro to an unidentified less polar metabolite. Formation of this metabolite was completely inhibited by preheating mouse plasma to 100 degrees C for 10 min. When mouse plasma was diluted 1:50 with water the half-life of phyllanthoside disappearance at 37 degrees C was 2.0 min. Breakdown of phyllanthoside in plasma from other species was slower than in mouse and the initial half-life at 37 degrees C in dog plasma was 30 min, in monkey plasma 33 min and in human plasma 38 min. The same less polar metabolite as in mouse plasma was formed slowly by plasma of monkey and dog. Phyllanthoside did not accumulate in human red blood cells. Binding of phyllanthoside to human plasma protein determined by ultrafiltration at 4 degrees C was 70%.

Animals↗
PubMed1985

Comparison of barium swallow and ultrasound in diagnosis of gastro-oesophageal reflux in children.

Fifty one infants and older children with suspected gastro-oesophageal reflux entered a study comparing the diagnostic accuracy of a standard barium swallow examination with that of ultrasound scanning. All children were examined by both techniques. In 40 cases there was unequivocal agreement between the examinations. Of the remaining patients, four had definite reflux by ultrasonic criteria but showed no evidence of reflux on barium swallow examination, four had positive findings on ultrasound but showed only minimal reflux on barium swallow, and one showed minimal reflux on ultrasound but had a negative barium meal result. In two children the ultrasound study was inconclusive. Ultrasound has an important role in the diagnosis and follow up of patients under the age of 5 years with gastro-oesophageal reflux.

Adolescent↗
PubMed1985

Surgical templates for immediate denture insertion.

Criteria for an ideal surgical template for immediate dentures were presented. Laboratory and clinical studies were made of five types of templates. The Biostarformed template with improvements, followed by the sprinkled acrylic resin template, best fit the established criteria (Table I).

Alveoloplasty↗
PubMed1985

Noninvasive assessment of stroke risk in asymptomatic and nonhemispheric patients with suspected carotid disease. Five-year follow-up of 294 unoperated and 81 operated patients.

Based on the assumption that greater than or equal to 50% stenosis of the internal carotid artery increases stroke risk, noninvasive tests are being used to screen patients for prophylactic carotid endarterectomy. To assess the validity of this concept, 104 asymptomatic and 190 nonhemispheric patients referred for cerebrovascular tests were reviewed after 5 years. Carotid stenosis greater than or equal to 50% predicted a 15% stroke incidence at 2 years compared to a 3% incidence with 1-49% stenosis (p less than or equal to 0.05). Five-year cumulative stroke incidence was 21% with greater than 50% stenosis, 14% with 1-49% stenosis (NS), and 9% with 0% stenosis (p less than 0.05). Stenosis greater than or equal to 50% predicted increased cardiac mortality (p less than 0.025). Hypertensive patients, greater than 70 years, with greater than or equal to 50% stenosis had a 37% incidence of stroke; normotensive patients, less than 70 years, with or without stenosis, had few strokes. In patients with greater than or equal to 50% disease, surgery reduced the 5-year stroke rate from 21 to 8% (p less than 0.05), mitigated the effects of age and hypertension, and improved survival. Noninvasive test results must be considered in conjunction with age and hypertension in predicting stroke risk.

Actuarial Analysis↗
PubMed1985

Beneficial short-term effects of unprocessed wheat bran on lipid and glucose metabolism in man.

Supplementation of the normal diets of seven healthy 18-22-year old male and female volunteers with 0.15 g unprocessed wheat bran/kg body weight/d for 6 weeks increased fibre consumption by 35 per cent without noticeably affecting the intake of other major nutrients. Fasting concentrations of plasma total cholesterol, triglyceride and glucose were unchanged by wheat bran supplementation, whereas HDL-cholesterol was increased and LDL-cholesterol decreased by 46 per cent and 25 per cent respectively after 6 weeks. Glycosylated haemoglobin was decreased by 18 per cent, 27 per cent and 45 per cent after 2, 4 and 6 weeks. The results illustrate the potential value of consuming relatively small amounts of unprocessed wheat bran for the promotion of health and treatment of certain metabolic diseases in man.

Adolescent↗
PubMed1985

Digital subtraction angiography: intravenous and intra-arterial techniques.

As experience with digital subtraction angiography (DSA) increases, both its advantages and disadvantages have become more evident. Although the intravenous approach (IV-DSA) is safer and less expensive than conventional arteriography, images are frequently suboptimal. Good-quality IV-DSAs quite accurately detect hemodynamically significant lesions (sensitivity 92% and specificity 92%) but may overlook minor stenoses and wall irregularities (negative predictive value 69%). When fine detail is not required, IV-DSA may serve as the definitive radiographic examination. The intra-arterial approach (IA-DSA), which provides better images, uses less contrast medium, decreases the need for selective catheterization, and permits visualization of vessels in areas of sluggish flow, is being used more extensively. Careful consideration of the complementary roles of DSA, conventional arteriography, and noninvasive testing is necessary to provide accurate diagnostic information at the least hazard and expense to the patient.

Angiography↗